Global, regional, and national incidence, prevalence, and mortality of HIV, 1980-2017, and forecasts to 2030, for 195 countries and territories: a systematic analysis for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017.,The Lancet HIV

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Global, regional, and national incidence, prevalence, and mortality of HIV, 1980-2017, and forecasts to 2030, for 195 countries and territories: a systematic analysis for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017.
The Lancet HIV ( IF 16.1 ) Pub Date : 2019-08-19 , DOI: 10.1016/s2352-3018(19)30196-1
Tahvi D Frank , Austin Carter , Deepa Jahagirdar , Molly H Biehl , Dirk Douwes-Schultz , Samantha Leigh Larson , Megha Arora , Laura Dwyer-Lindgren , Krista M Steuben , Hedayat Abbastabar , Laith Jamal Abu-Raddad , Direslgne Misker Abyu , Maryam Adabi , Oladimeji M Adebayo , Victor Adekanmbi , Olatunji O Adetokunboh , Alireza Ahmadi , Keivan Ahmadi , Elham Ahmadian , Ehsan Ahmadpour , Muktar Beshir Ahmed , Chalachew Genet Akal , Fares Alahdab , Noore Alam , Samuel B Albertson , Birhan Tamene T Alemnew , Kefyalew Addis Alene , Vahid Alipour , Nelson Alvis-Guzman , Saeed Amini , Zohreh Anbari , Nahla Hamed Anber , Mina Anjomshoa , Carl Abelardo T Antonio , Jalal Arabloo , Olatunde Aremu , Habtamu Abera Areri , Ephrem Tsegay Asfaw , Alebachew Fasil Ashagre , Daniel Asmelash , Anemaw A Asrat , Euripide F G A Avokpaho , Ashish Awasthi , Nefsu Awoke , Martin Amogre Ayanore , Samad Azari , Alaa Badawi , Mojtaba Bagherzadeh , Maciej Banach , Aleksandra Barac , Till Winfried Bärnighausen , Sanjay Basu , Neeraj Bedi , Masoud Behzadifar , Bayu Begashaw Bekele , Saba Abraham Belay , Yared Belete Belay , Yaschilal Muche Belayneh , Adugnaw Berhane , Anusha Ganapati Bhat , Krittika Bhattacharyya , Belete Biadgo , Ali Bijani , Muhammad Shahdaat Bin Sayeed , Helen Bitew , Andrew Blinov , Kassawmar Angaw Bogale , Hunduma Amensisa Bojia , Sharath B N Burugina Nagaraja , Zahid A Butt , Lucero Cahuana-Hurtado , Julio Cesar Campuzano Rincon , Félix Carvalho , Vijay Kumar Chattu , Devasahayam J Christopher , Dinh-Toi Chu , Raquel Crider , Tukur Dahiru , Lalit Dandona , Rakhi Dandona , Ahmad Daryani , José das Neves , Jan-Walter De Neve , Louisa Degenhardt , Feleke Mekonnen Demeke , Asmamaw Bizuneh Demis , Dereje Bayissa Demissie , Gebre Teklemariam Demoz , Kebede Deribe , Don Des Jarlais , Govinda Prasad Dhungana , Daniel Diaz , Shirin Djalalinia , Huyen Phuc Do , Linh Phuong Doan , Herbert Duber , Manisha Dubey , Eleonora Dubljanin , Eyasu Ejeta Duken , Bereket Duko Adema , Andem Effiong , Aziz Eftekhari , Maysaa El Sayed Zaki , Shaimaa I El-Jaafary , Ziad El-Khatib , Aisha Elsharkawy , Aman Yesuf Endries , Sharareh Eskandarieh , Oghenowede Eyawo , Farshad Farzadfar , Batool Fatima , Netsanet Fentahun , Eduarda Fernandes , Irina Filip , Florian Fischer , Morenike Oluwatoyin Folayan , Masoud Foroutan , Takeshi Fukumoto , Nancy Fullman , Alberto L Garcia-Basteiro , Reta Tsegaye Gayesa , Ketema Bizuwork Gebremedhin , Gebreamlak Gebremedhn Gebremedhn Gebremeskel , Kelali Kalaye Gebreyohannes , Getnet Azeze Gedefaw , Belayneh K Gelaw , Hailay Abrha Gesesew , Birhanu Geta , Kebede Embaye Gezae , Keyghobad Ghadiri , Ahmad Ghashghaee , Themba T G Ginindza , Harish Chander Gugnani , Rafael Alves Guimarães , Michael Tamene Haile , Gessessew Bugssa Hailu , Arvin Haj-Mirzaian , Arya Haj-Mirzaian , Samer Hamidi , Senad Handanagic , Demelash Woldeyohannes Handiso , Lolemo Kelbiso Hanfore , Amir Hasanzadeh , Hadi Hassankhani , Hamid Yimam Hassen , Simon I Hay , Andualem Henok , Chi Linh Hoang , H Dean Hosgood , Mehdi Hosseinzadeh , Mohamed Hsairi , Segun Emmanuel Ibitoye , Bulat Idrisov , Kevin S Ikuta , Olayinka Stephen Ilesanmi , Seyed Sina Naghibi Irvani , Chinwe Juliana Iwu , Kathryn H Jacobsen , Spencer L James , Ensiyeh Jenabi , Ravi Prakash Jha , Jost B Jonas , Zahra Jorjoran Shushtari , Ali Kabir , Zubair Kabir , Rajendra Kadel , Amir Kasaeian , Belete Kassa , Getachew Mullu Kassa , Tesfaye Dessale Kassa , Gbenga A Kayode , Mihiretu M Kebede , Adane Teshome Kefale , Andre Pascal Kengne , Yousef Saleh Khader , Morteza Abdullatif Khafaie , Nauman Khalid , Ejaz Ahmad Khan , Gulfaraz Khan , Junaid Khan , Young-Ho Khang , Khaled Khatab , Salman Khazaei , Abdullah T Khoja , Aliasghar A Kiadaliri , Yun Jin Kim , Adnan Kisa , Sezer Kisa , Sonali Kochhar , Hamidreza Komaki , Parvaiz A Koul , Ai Koyanagi , Barthelemy Kuate Defo , G Anil Kumar , Manasi Kumar , Desmond Kuupiel , Dharmesh Kumar Lal , Jane Jean-Hee Lee , Tsegaye Lolaso Lenjebo , Cheru Tesema Leshargie , Erlyn Rachelle King Macarayan , Emilie R Maddison , Hassan Magdy Abd El Razek , Carlos Magis-Rodriguez , Phetole Walter Mahasha , Marek Majdan , Azeem Majeed , Reza Malekzadeh , Navid Manafi , Chabila Christopher Mapoma , Francisco Rogerlândio Martins-Melo , Anthony Masaka , Emmanuel Ngassa Laurent Mayenga , Varshil Mehta , Gebrekiros Gebremichael Meles , Hagazi Gebre Meles , Addisu Melese , Mulugeta Melku , Peter T N Memiah , Ziad A Memish , Alemayehu Toma Mena , Walter Mendoza , Desalegn Tadese Mengistu , Getnet Mengistu , Tuomo J Meretoja , Tomislav Mestrovic , Ted R Miller , Babak Moazen , Bahram Mohajer , Amjad Mohamadi-Bolbanabad , Karzan Abdulmuhsin Mohammad , Yousef Mohammad , Aso Mohammad Darwesh , Naser Mohammad Gholi Mezerji , Moslem Mohammadi , Roghayeh Mohammadibakhsh , Milad Mohammadoo-Khorasani , Jemal Abdu Mohammed , Shafiu Mohammed , Farnam Mohebi , Ali H Mokdad , Yoshan Moodley , Maryam Moossavi , Ghobad Moradi , Maziar Moradi-Lakeh , Marilita M Moschos , Tilahun Belete Mossie , Seyyed Meysam Mousavi , Kindie Fentahun Muchie , Atalay Goshu Muluneh , Moses K Muriithi , Ghulam Mustafa , Saravanan Muthupandian , Ahamarshan Jayaraman Nagarajan , Gurudatta Naik , Farid Najafi , Javad Nazari , Duduzile Edith Ndwandwe , Cuong Tat Nguyen , Huong Lan Thi Nguyen , Son Hoang Nguyen , Trang Huyen Nguyen , Dina Nur Anggraini Ningrum , Molly R Nixon , Chukwudi A Nnaji , Mehdi Noroozi , Jean Jacques Noubiap , Malihe Nourollahpour Shiadeh , Mohammed Suleiman Obsa , Emmanuel Ankrah Odame , Richard Ofori-Asenso , Felix Akpojene Ogbo , Anselm Okoro , Olanrewaju Oladimeji , Andrew T Olagunju , Tinuke O Olagunju , Solomon Olum , Kwaku Oppong Asante Oppong Asante , Eyal Oren , Stanislav S Otstavnov , Mahesh PA , Jagadish Rao Padubidri , Smita Pakhale , Amir H Pakpour , Sangram Kishor Patel , Kebreab Paulos , Veincent Christian Filipino Pepito , Emmanuel K Peprah , Bakhtiar Piroozi , Akram Pourshams , Mostafa Qorbani , Mohammad Rabiee , Navid Rabiee , Amir Radfar , Anwar Rafay , Alireza Rafiei , Fakher Rahim , Afarin Rahimi-Movaghar , Vafa Rahimi-Movaghar , Sajjad ur Rahman , Chhabi Lal Ranabhat , Salman Rawaf , Cesar Reis , Vishnu Renjith , Melese Abate Reta , Mohammad Sadegh Rezai , Carlos Miguel Rios González , Elias Merdassa Roro , Ali Rostami , Salvatore Rubino , Sahar Saeedi Moghaddam , Saeed Safari , Rajesh Sagar , Mohammad Ali Sahraian , Marwa R Rashad Salem , Yahya Salimi , Joshua A Salomon , Evanson Zondani Sambala , Abdallah M Samy , Benn Sartorius , Maheswar Satpathy , Monika Sawhney , Mehdi Sayyah , Aletta Elisabeth Schutte , Sadaf G Sepanlou , Seyedmojtaba Seyedmousavi , Hosein Shabaninejad , Amira A Shaheen , Masood Ali Shaikh , Seifadin Ahmed Shallo , Morteza Shamsizadeh , Hamid Sharifi , Kenji Shibuya , Jae Il Shin , Reza Shirkoohi , Diego Augusto Santos Silva , Dayane Gabriele Alves Silveira , Jasvinder A Singh , Malede Mequanent M Sisay , Mekonnen Sisay , Solomon Sisay , Amanda E Smith , Anton Sokhan , Ranjani Somayaji , Sergey Soshnikov , Dan J Stein , Mu'awiyyah Babale Sufiyan , Bruno F Sunguya , Bryan L Sykes , Birkneh Tilahun Tadesse , Degena Bahrey Tadesse , Koku Sisay Tamirat , Nuno Taveira , Shishay Wahdey Tekelemedhin , Habtamu Denekew Temesgen , Fisaha Haile Tesfay , Manaye Yihune Teshale , Subash Thapa , Kenean Getaneh Tlaye , Stephanie M Topp , Marcos Roberto Tovani-Palone , Bach Xuan Tran , Khanh Bao Tran , Irfan Ullah , Bhaskaran Unnikrishnan , Olalekan A Uthman , Yousef Veisani , Sergey Konstantinovitch Vladimirov , Fiseha Wadilo Wada , Yasir Waheed , Kidu Gidey Weldegwergs , Girmay Teklay T Weldesamuel , Ronny Westerman , Tissa Wijeratne , Haileab Fekadu Wolde , Dawit Zewdu Wondafrash , Tewodros Eshete Wonde , Berhanu Yazew Wondmagegn , Addisu Gize Yeshanew , Mekdes Tigistu Yilma , Ebrahim M Yimer , Naohiro Yonemoto , Marcel Yotebieng , Yoosik Youm , Chuanhua Yu , Zoubida Zaidi , Afshin Zarghi , Zerihun Menlkalew Zenebe , Taye Abuhay Zewale , Arash Ziapour , Sanjay Zodpey , Mohsen Naghavi , Stein Emil Vollset , Haidong Wang , Stephen S Lim , Hmwe Hmwe Kyu , Christopher J L Murray

Background

Understanding the patterns of HIV/AIDS epidemics is crucial to tracking and monitoring the progress of prevention and control efforts in countries. We provide a comprehensive assessment of the levels and trends of HIV/AIDS incidence, prevalence, mortality, and coverage of antiretroviral therapy (ART) for 1980–2017 and forecast these estimates to 2030 for 195 countries and territories.

Methods

We determined a modelling strategy for each country on the basis of the availability and quality of data. For countries and territories with data from population-based seroprevalence surveys or antenatal care clinics, we estimated prevalence and incidence using an open-source version of the Estimation and Projection Package—a natural history model originally developed by the UNAIDS Reference Group on Estimates, Modelling, and Projections. For countries with cause-specific vital registration data, we corrected data for garbage coding (ie, deaths coded to an intermediate, immediate, or poorly defined cause) and HIV misclassification. We developed a process of cohort incidence bias adjustment to use information on survival and deaths recorded in vital registration to back-calculate HIV incidence. For countries without any representative data on HIV, we produced incidence estimates by pulling information from observed bias in the geographical region. We used a re-coded version of the Spectrum model (a cohort component model that uses rates of disease progression and HIV mortality on and off ART) to produce age-sex-specific incidence, prevalence, and mortality, and treatment coverage results for all countries, and forecast these measures to 2030 using Spectrum with inputs that were extended on the basis of past trends in treatment scale-up and new infections.

Findings

Global HIV mortality peaked in 2006 with 1·95 million deaths (95% uncertainty interval 1·87–2·04) and has since decreased to 0·95 million deaths (0·91–1·01) in 2017. New cases of HIV globally peaked in 1999 (3·16 million, 2·79–3·67) and since then have gradually decreased to 1·94 million (1·63–2·29) in 2017. These trends, along with ART scale-up, have globally resulted in increased prevalence, with 36·8 million (34·8–39·2) people living with HIV in 2017. Prevalence of HIV was highest in southern sub-Saharan Africa in 2017, and countries in the region had ART coverage ranging from 65·7% in Lesotho to 85·7% in eSwatini. Our forecasts showed that 54 countries will meet the UNAIDS target of 81% ART coverage by 2020 and 12 countries are on track to meet 90% ART coverage by 2030. Forecasted results estimate that few countries will meet the UNAIDS 2020 and 2030 mortality and incidence targets.

Interpretation

Despite progress in reducing HIV-related mortality over the past decade, slow decreases in incidence, combined with the current context of stagnated funding for related interventions, mean that many countries are not on track to reach the 2020 and 2030 global targets for reduction in incidence and mortality. With a growing population of people living with HIV, it will continue to be a major threat to public health for years to come. The pace of progress needs to be hastened by continuing to expand access to ART and increasing investments in proven HIV prevention initiatives that can be scaled up to have population-level impact.

Funding

Bill & Melinda Gates Foundation, National Institute of Mental Health of the US National Institutes of Health (NIH), and the National Institute on Aging of the NIH.

中文翻译：

全球、区域和国家艾滋病毒的发病率、流行率和死亡率，1980-2017 年，以及到 2030 年的预测，195 个国家和地区：对 2017 年全球疾病负担、伤害和风险因素研究的系统分析。

背景

了解艾滋病毒/艾滋病流行的模式对于跟踪和监测各国预防和控制工作的进展至关重要。我们对 1980-2017 年 HIV/AIDS 发病率、流行率、死亡率和抗逆转录病毒治疗 (ART) 覆盖率的水平和趋势进行了全面评估，并预测到 2030 年 195 个国家和地区的这些估计值。

方法

我们根据数据的可用性和质量确定了每个国家的建模策略。对于拥有基于人群的血清阳性率调查或产前保健诊所数据的国家和地区，我们使用开源版本的估计和预测包估计患病率和发病率——这是一种最初由联合国艾滋病规划署估计、建模参考小组开发的自然历史模型和预测。对于具有特定原因的生命登记数据的国家，我们更正了垃圾编码（即，死亡编码为中间、直接或定义不明确的原因）和 HIV 错误分类的数据。我们开发了一个队列发病率偏差调整过程，以使用生命登记中记录的生存和死亡信息来反算 HIV 发病率。对于没有任何艾滋病毒代表性数据的国家，我们通过从地理区域观察到的偏差中提取信息来得出发病率估计值。我们使用了重新编码的 Spectrum 模型（一个使用 ART 前后疾病进展率和 HIV 死亡率的队列组件模型）来为所有人群生成特定年龄性别的发病率、流行率和死亡率以及治疗覆盖率结果国家，并使用 Spectrum 预测这些措施到 2030 年，并根据过去治疗扩大和新感染的趋势进行扩展。

发现

全球 HIV 死亡率在 2006 年达到顶峰，死亡人数为 1·9500 万人（95% 的不确定性区间为 1·87-2·04），此后在 2017 年降至 0·9500 万人（0·91-1·01）。全球艾滋病毒在 1999 年达到顶峰（3·1600 万，2·79–3·67），此后逐渐下降到 2017 年的 1·9400 万（1·63–2·29）。这些趋势以及 ART 规模-上，导致全球艾滋病毒感染率上升，2017 年有 36·8 百万 (34·8–39·2) 人感染了艾滋病毒。2017 年，撒哈拉以南非洲南部的艾滋病毒流行率最高，该地区的国家已经ART 覆盖率从莱索托的 65·7% 到 eSwatini 的 85·7% 不等。我们的预测显示，到 2020 年，54 个国家将实现联合国艾滋病规划署 81% 的抗逆转录病毒治疗覆盖率的目标，而 12 个国家有望在 2030 年实现 90% 的抗逆转录病毒治疗覆盖率。

解释

尽管过去十年在降低 HIV 相关死亡率方面取得了进展，但发病率缓慢下降，加上目前相关干预措施资金停滞不前，这意味着许多国家无法实现 2020 年和 2030 年降低发病率的全球目标和死亡率。随着艾滋病毒携带者人数的不断增加，它将在未来几年继续成为对公共健康的主要威胁。需要通过继续扩大抗逆转录病毒治疗的可及性和增加对经验证的艾滋病毒预防举措的投资来加快进展步伐，这些举措可以扩大规模以产生人口层面的影响。