Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Dec;11(12):e807-e822.
doi: 10.1016/S2352-3018(24)00212-1. Epub 2024 Nov 25.

Global, regional, and national burden of HIV/AIDS, 1990-2021, and forecasts to 2050, for 204 countries and territories: the Global Burden of Disease Study 2021

GBD 2021 HIV Collaborators
Collaborators

Global, regional, and national burden of HIV/AIDS, 1990-2021, and forecasts to 2050, for 204 countries and territories: the Global Burden of Disease Study 2021

GBD 2021 HIV Collaborators. Lancet HIV. 2024 Dec.

Abstract

Background: As set out in Sustainable Development Goal 3.3, the target date for ending the HIV epidemic as a public health threat is 2030. Therefore, there is a crucial need to evaluate current epidemiological trends and monitor global progress towards HIV incidence and mortality reduction goals. In this analysis, we assess the current burden of HIV in 204 countries and territories and forecast HIV incidence, prevalence, and mortality up to 2050 to allow countries to plan for a sustained response with an increasing number of people living with HIV globally.

Methods: We used the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 analytical framework to compute age-sex-specific HIV mortality, incidence, and prevalence estimates for 204 countries and territories (1990-2021). We aimed to analyse all available data sources, including data on the provision of HIV programmes reported to UNAIDS, published literature on mortality among people on antiretroviral therapy (ART) identified by a systematic review, household surveys, sentinel surveillance antenatal care clinic data, vital registration data, and country-level case report data. We calibrated a mechanistic simulation of HIV infection and natural history to available data to estimate HIV burden from 1990 to 2021 and generated forecasts to 2050 through projection of all simulation inputs into the future. Historical outcomes (1990-2021) were simulated at the 1000-draw level to support propagation of uncertainty and reporting of uncertainty intervals (UIs). Our approach to forecasting utilised the transmission rate as the basis for projection, along with new rate-of-change projections of ART coverage. Additionally, we introduced two new metrics to our reporting: prevalence of unsuppressed viraemia (PUV), which represents the proportion of the population without a suppressed level of HIV (viral load <1000 copies per mL), and period lifetime probability of HIV acquisition, which quantifies the hypothetical probability of acquiring HIV for a synthetic cohort, a simulated population that is aged from birth to death through the set of age-specific incidence rates of a given time period.

Findings: Global new HIV infections decreased by 21·9% (95% UI 13·1-28·8) between 2010 and 2021, from 2·11 million (2·02-2·25) in 2010 to 1·65 million (1·48-1·82) in 2021. HIV-related deaths decreased by 39·7% (33·7-44·5), from 1·19 million (1·07-1·37) in 2010 to 718 000 (669 000-785 000) in 2021. The largest declines in both HIV incidence and mortality were in sub-Saharan Africa and south Asia. However, super-regions including central Europe, eastern Europe, and central Asia, and north Africa and the Middle East experienced increasing HIV incidence and mortality rates. The number of people living with HIV reached 40·0 million (38·0-42·4) in 2021, an increase from 29·5 million (28·1-31·0) in 2010. The lifetime probability of HIV acquisition remains highest in the sub-Saharan Africa super-region, where it declined from its 1995 peak of 21·8% (20·1-24·2) to 8·7% (7·5-10·7) in 2021. Four of the seven GBD super-regions had a lifetime probability of less than 1% in 2021. In 2021, sub-Saharan Africa had the highest PUV of 999·9 (857·4-1154·2) per 100 000 population, but this was a 64·5% (58·8-69·4) reduction in PUV from 2003 to 2021. In the same period, PUV increased in central Europe, eastern Europe, and central Asia by 116·1% (8·0-218·2). Our forecasts predict a continued global decline in HIV incidence and mortality, with the number of people living with HIV peaking at 44·4 million (40·7-49·8) by 2039, followed by a gradual decrease. In 2025, we projected 1·43 million (1·29-1·59) new HIV infections and 615 000 (567 000-680 000) HIV-related deaths, suggesting that the interim 2025 targets for reducing these figures are unlikely to be achieved. Furthermore, our forecasted results indicate that few countries will meet the 2030 target for reducing HIV incidence and HIV-related deaths by 90% from 2010 levels.

Interpretation: Our forecasts indicate that continuation of current levels of HIV control are not likely to attain ambitious incidence and mortality reduction targets by 2030, and more than 40 million people globally will continue to require lifelong ART for decades into the future. The global community will need to show sustained and substantive efforts to make the progress needed to reach and sustain the end of AIDS as a public threat.

Funding: The Bill & Melinda Gates Foundation and the National Institute of Allergy and Infectious Diseases.

PubMed Disclaimer

Conflict of interest statement

Declaration of interests S Afzal reports support for the present manuscript from King Edward Medical University; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from King Edward Medical University and collaborative partners including Johns Hopkins University, University of California, University of Massachusetts, KEMCAANA, and KEMCA_UK international scientific conferences; support for attending meetings or travel from King Edward Medical University; participation on a Data safety monitoring board or advisory board with National Bioethics Committee Pakistan, King Edward Medical University Ethical Review Board, and Ethical Review Board of Fatimah Jinnah Medical University, and Sir Ganga Ram Hospital; leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with King Edward Medical University as Dean of Public Health and Preventive Medicine as well as Director of Quality Enhancement Cell and Annals of King Edward Medical University since 2014 as Chief Editor, Pakistan Association of Medical Editors as Member, Technical Expert Advisory Group of the Government as Member, Faculty of Public Health Royal Colleges UK (FFPH) as Fellow, Society of Prevention, Advocacy And Research, King Edward Medical University (SPARK) as Member, Pakistan Society of Infectious Diseases, Technical Expert Advisory Group of the Government as Member, Scientific Session, KEMCA-UK as Advisory Board Member and Chair, International Scientific Conference, KEMCAANA as Chairperson, Research and Publications Higher Education Commission, HEC Pakistan as Member, Research and Journals Committee Pakistan Medical and Dental Council, Pakistan as Member, National Bioethics Committee, Pakistan as Member, Corona Experts Advisory Group as Member, Technical Working Group for Infectious Diseases as Member, Dengue Experts Advisory Group as Member, and Punjab Residency Program Research Committee as Chair. T W Bärnighausen reports grants or contracts from the National Institutes of Health (NIH), Alexander von Humboldt Foundation, German National Research Foundation (DFG), EU, German Ministry of Educational and Research, Germany Ministry of the Environment, Wellcome, and KfW; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from PLOS as Editor-in-Chief; participation on a data safety monitoring board or advisory board with scientific advisory boards for NIH-funded research projects in Africa on climate change and health; and stock or stock options in CHEERS. A Beloukas reports grants or contracts from Gilead and GSK to the University of West Attica; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Gilead and GSK; support for attending meetings or travel from Gilead and GSK; receipt of equipment, materials, drugs, medical writing, gifts, or other services from Cepheid. C S Brown reports support from occasional contributions to market research, outside the submitted work. L Degenhardt reports leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid, with AIDS Council of NSW Board as the volunteer Vice President of the Board. I M Ilic reports support for the present manuscript from Ministry of Education, Science and Technological Development, Republic of Serbia for project number 175042, 2011–2023. N E Ismail reports leadership or fiduciary roles in board, society, committee, or advocacy groups, paid or unpaid, with Malaysian Academy of Pharmacy, Malaysia, as Bursar and Council Member, and Malaysian Pharmacists Society Education Chapter, Malaysia, as Committee Member. K Krishan reports non-financial support from the UGC Centre of Advanced Study, CAS II, awarded to the Department of Anthropology, Panjab University, Chandigarh, India. M Li reports grants or contracts from the National Science and Technology Council, Taiwan (NSTC 112-2410-H-003–031); leadership or fiduciary roles in board, society, committee, or advocacy groups, paid or unpaid, with the Journal of the American Heart Association as a Technical Editor. W Mendoza reports support in his role as Program Analyst in Population and Development at the UN Population Fund Country Office in Peru, an institution which does not necessarily endorse this study. P Meylakhs reports support for the present manuscript and grants or contracts from the Russian Science Foundation (grant 23-15-00428). L Monasta acknowledges support for the present manuscript from the Italian Ministry of Health (Ricerca Corrente 34/2017), payments made to the Institute for Maternal and Child Health IRCCS Burlo Garofolo. E A Mpolya reports support for the present manuscript and support for attending meetings or travel from the Department of State, USA, which provided funding for a Fulbright Senior Visiting Fellowship at the Institute for Health Metrics and Evaluation between August, 2023, and April, 2024. A P Okekunle reports support for the present manuscript and support for attending meetings or travel from the National Research Foundation of Korea funded by the Ministry of Science and ICT (2020H1D3A1A04081265). C Palladino reports grants or contracts from Fundação para a Ciência e a Tecnologia, I P (national funding), under a contract programme as defined by DL number 57/2016 and law number 57/2017 (DL57/2016/CP1376/CT0004; DOI 10.54499/DL57/2016/CP1376/CT0004). V C F Pepito reports grants or contracts from Sanofi Consumer Healthcare and the International Initiative for Impact Evaluation. A Sharifan reports leadership or fiduciary roles in board, society, committee, or advocacy groups with Cochrane as an unpaid steering member of the Cochrane Early Career Professionals Network; receipt of equipment, materials, drugs, medical writing, gifts, or other services from Elsevier and Cochrane. S Shrestha reports support from the School of Pharmacy, Monash University Malaysia, as recipient of a Graduate Research Merit Scholarship. J A Singh reports consulting fees from ROMTech, Atheneum, Clearview Healthcare Partners, American College of Rheumatology, Yale, Hulio, Horizon Pharmaceuticals, DINORA, Frictionless Solutions, Schipher, Crealta/Horizon, Medisys, Fidia, PK Med, Two Labs, Adept Field Solutions, Clinical Care Options, Putnam Associates, Focus Forward, Navigant Consulting, Spherix, MedIQ, Jupiter Life Science, UBM, Trio Health, Medscape, WebMD, Practice Point Communications, and NIH; payment or honoraria for speakers bureaus from Simply Speaking; support for attending meetings or travel from OMERACT as a past steering committee member; leadership or fiduciary roles in board, society, committee, or advocacy groups, paid or unpaid with OMERACT as a past steering committee member, Veterans Affairs Rheumatology Field Advisory Committee as Chair, and USA Cochrane Musculoskeletal Group Satellite Center on Network Meta-analysis as Editor and Director; stock or stock options in Atai Life Sciences, Kintara Therapeutics, Intelligent Biosolutions, Acumen Pharmaceutical, TPT Global Tech, Vaxart Pharmaceuticals, Atyu Biopharma, Adaptimmune Therapeutics, GeoVax Labs, Pieris Pharmaceuticals, Enzolytics, Seres Therapeutics, Tonix Pharmaceuticals Holding Corp, Aebona Pharmaceuticals, and Charlotte's Web Holdings, as well as previously owned stock options in Amarin, Viking, and Moderna Pharmaceuticals. A C Tsai reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Elsevier; participation on a data safety monitoring board for Piloting Risk Stratification and Tailored Interventions with Pregnant and Postpartum Women with HIV in Kenya to Prevent Disengagement from Care and Viral Failure (NIH R34MH126857, MPI: L Abuogi, M Onono, J Turan); leadership or fiduciary roles in board, society, committee, or advocacy groups, paid or unpaid, with Interdisciplinary Association for Population Health Science as a member of the Board of Directors. M Zielińska reports support as an AstraZenaca employee. A Zumla reports support for the present manuscript from the Pan-African Network on Emerging and Re-Emerging Infections (PANDORA-ID-NET) funded by the EDCTP—the EU Horizon 2020 Framework Programme; grants or contracts from UK NIHR Senior Investigator Award, Mahathir Science Award, and EU-EDCTP Pascoal Mocumbi Prize Laureate; participation on a data safety monitoring board or advisory board with WHO Infection Prevention Control Acute Respiratory Infections Guideline Development Group as a Member; leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid, with the Institute of Medicine, University of Bolton, UK, as a Board Member.

Figures

Figure 1
Figure 1
Temporal trends of HIV incidence, mortality, and prevalence counts for 1990–2050 Time trends presented for all-age males, females, and both sexes combined. The shaded areas represent 95% uncertainty intervals.
Figure 2
Figure 2
HIV incidence (A) and mortality (B) rates for both sexes combined in 2021, age-standardised Rates are presented per 100 000 individuals.
Figure 3
Figure 3
Period lifetime probability of HIV infection by GBD super-region Each line represents the period lifetime probability of HIV acquisition for each GBD super-region. The shaded areas represent 95% uncertainty intervals. GBD=Global Burden of Diseases, Injuries, and Risk Factors Study.
Figure 4
Figure 4
Map of PUV in 2021 PUV=prevalence of unsuppressed viraemia.
See this image and copyright information in PMC

References

    1. WHO . World Health Organization; Geneva: 2021. Consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring: recommendations for a public health approach. - PubMed
    1. Jahagirdar D, Walters MK, Novotney A, et al. Global, regional, and national sex-specific burden and control of the HIV epidemic, 1990–2019, for 204 countries and territories: the Global Burden of Diseases Study 2019. Lancet HIV. 2021;8:e633–e651. - PMC - PubMed
    1. United Nations Declaration of commitment on HIV/AIDS—United Nations General Assembly Special Session on HIV/AIDS. 2001. https://data.unaids.org/publications/irc-pub03/aidsdeclaration_en.pdf
    1. United Nations 60/262. Political declaration on HIV/AIDS. June 15, 2006. https://www.unaids.org/sites/default/files/sub_landing/files/20060615_hl...
    1. United Nations 65/277. Political declaration on HIV and AIDS: intensifying our efforts to eliminate HIV and AIDS. July 8, 2011. https://www.unaids.org/sites/default/files/sub_landing/files/20110610_UN...

MeSH terms