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
Author(s)
Meixin Zhang
Khai Hoan Tram
Magdalene K Walters
Deepa Jahagirdar
Edmond D Brewer
Amanda Novotney
Dylan Lasher
Emmanuel Mpolya
Avina Vongpradith
Jianing Ma
Megan Verma
Tahvi Frank
Jiawei He
Sam Byrne
Christine Lin
Regina-Mae Villanueva Dominguez
Spencer A Pease
Haley Comfort
Erin A May
Yohannes Abate
Hedayat Abbastabar
Atef Abdelkader
Parsa Abdi
Meriem Abdoun
Jeza Muhamad Abdul Aziz
Hassan Abidi
Olumide Abiodun
Richard Gyan Aboagye
Lucas Guimarães Abreu
Yonas Derso Abtew
Eman Abu‐Gharbieh
Salahdein Aburuz
Ahmed Abu‐Zaid
Isaac Yeboah Addo
Oyelola A. Adegboye
Victor Adekanmbi
Charles Oluwaseun Adetunji
Juliana Bunmi Adetunji
Daniel A Adeyinka
Kishor Adhikari
Qorinah Estiningtyas Sakilah Adnani
Leticia Akua Adzigbli
Fatemeh Afrashteh
Saira Afzal
Shahin Aghamiri
Feleke Doyore Agide
Antonella Agodi
Williams Agyemang‐Duah
Bright Opoku Ahinkorah
Faisal Ahmad
Sajjad Ahmad
Shahzaib Ahmad
Aqeel Ahmad
Ibrar Ahmed
Haroon Ahmed
Syed Anees Ahmed
Safoora Ahmed
Ali Ahmed
Mohammed Ahmed
Ayman Ahmed
Gizachew Taddesse Akalu
Karolina Akinosoglou
Salah Al Awaidy
Hanadi Al Hamad
Amjad S Al Mosa
Omar Ali Mohammed Al Zaabi
Samer O Alalalmeh
Nazmul Alam
Noore Alam
Fahad Alanezi
Daniel Shewaye Alayu
Mohammad T AlBataineh
Seyedeh Yasaman Alemohammad
Adel Al‐Gheethi
Syed Shujait Ali
Mohammed Usman Ali
Abid Ali
Liaqat Ali
Waad Ali
Akram Al‐Ibraheem
Joseph Uy Almazan
Awais Altaf
Diala Altwalbeh
Nelson Alvis‐Guzmán
Walid Al-Zyoud
Reza Amani
Tewodros Getnet Amera
Edward Kwabena Ameyaw
Sohrab Amiri
Hubert Amu
Ganiyu Adeniyi Amusa
Abhishek Anil
AbdulAzeez Adeyemi Anjorin
Carl Abelardo T Antonio
Saleha Anwar
Razique Anwer
Ekenedilichukwu Emmanuel Anyabolo
Anayochukwu Edward Anyasodor
Geminn Louis Carace Apostol
Ali M. Ardekani
er Areda
Brhane Berhe Aregawi
Abdulfatai Aremu
Keivan Armani
Mulusew Andualem Asemahagn
Mubarek Yesse Ashemo
Tahira Ashraf
Marvellous O Asika
Haftu Asmerom
Maha Atout
Avinash Aujayeb
Hamzeh Awad
Adedapo Wasiu Awotidebe
Beatriz Paulina Ayala Quintanilla
Firayad Ayele
Sina Azadnajafabad
Shahkaar Aziz
B B Darshan
Giridhara R. Babu
Muhammad Badar
Saeed Bahramian
Abdulaziz Bako
Wondu Feyisa Balcha
Kiran Bam
Biswajit Banik
Mainak Bardhan
Till Bärnighausen
Hiba Jawdat Barqawi
Zarrin Basharat
Hameed Akande Bashiru
Afisu Basiru
Mohammad‐Mahdi Bastan
Saurav Basu
Prapthi Persis Bathini
Kavita Batra
Ravi Batra
Nebiyou Simegnew Bayileyegn
Tahmina Begum
Amir Hossein Behnoush
Maryam Beiranvand
Melaku Ashagrie Belete
Abel Cherkos Belete
Apostolos Beloukas
Alice A Beneke
Azizullah Beran
Alemshet Yirga Berhie
Amiel Nazer C Bermudez
Robert S. Bernstein
Kebede Beyene
Pankaj Bhardwaj
Nikha Bhardwaj
Ajay Nagesh Bhat
Vivek Bhat
Gurjit Kaur Bhatti
Jasvinder Singh Bhatti
Keralem Anteneh Bishaw
Khushboo D Bisht
Trupti Bodhare
Aadam Olalekan Bodunrin
Azizbek Boltaev
Hamed Borhany
Souad Bouaoud
Colin Brown
Danilo Buonsenso
Katrin Burkart
Yasser Bustanji
Zahid A Butt
Chao Cao
Rosario Cárdenas
Muthia Cenderadewi
Joshua Chadwick
Chiranjib Chakraborty
Sandip Chakraborty
Rama Mohan Chandika
Vijay Kumar Chattu
Akhilanand Chaurasia
Guangjin Chen
Patrick R Ching
Hitesh Chopra
Sonali G Choudhari
Dinh‐Toi Chu
Isaac Sunday Chukwu
Eric Lim Teik Chung
Zinhle Cindi
Rosa A S Couto
Natália Martins
Silvia Magali Cuadra-Hernández
Bashir Dabo
Omid Dadras
Gizachew Worku Dagnew
Tukur Dahiru
Xiaochen Dai
Aso Mohammad Darwesh
José das Neves
Nihar Ranjan Dash
Mohsen Dashti
Fernando de la Hoz
Shayom Debopadhaya
Louisa Degenhardt
Iván Delgado‐Enciso
Kebede Deribe
Don C. Des Jarlais
Hardik Dineshbhai Desai
Keshab Deuba
Amol S. Dhane
Sameer Dhingra
Daniel Díaz
Michael R Diaz
Delaney D Ding
Thanh Chi
Sushil Dohare
Deepa Dongarwar
Wendel Mombaque dos Santos
Ojas Prakashbhai Doshi
Ashel Chelsea Dsouza
Haneil Larson Dsouza
Viola Savy Dsouza
Senbagam Duraisamy
Arkadiusz Dziedzic
Alireza Ebrahimi
Abdelaziz Ed‐Dra
Hisham Atan Edinur
Ferry Efendi
Michael Ekholuenetale
Temitope Cyrus Ekundayo
Iman El Sayed
Muhammed Elhadi
Chadi Eltaha
Sharareh Eskandarieh
Majid Eslami
Ugochukwu Anthony Eze
Ayesha Fahim
Ali Fatehizadeh
Nelsensius Klau Fauk
Patrick Fazeli
Ginenus Fekadu
Nuno Ferreira
Belete Sewasew Firew
Florian Fischer
Morẹ́nikẹ́ Oluwátóyìn Foláyan
Behzad Foroutan
Takeshi Fukumoto
G Sridevi
Muktar A Gadanya
Abhay Gaidhane
Abduzhappar Gaipov
Aravind P. Gandhi
Mohammad Arfat Ganiyani
Miglas Welay Gebregergis
Mesfin Gebrehiwot
Teferi Gebru Gebremeskel
Motuma Erena Getachew
Keyghobad Ghadiri
Afsaneh Ghasemzadeh
Ahmad Ghashghaee
Ehsan Gholami
Nasim Gholizadeh
Mahsa Ghorbani
Artyom Gil
Alem Girmay
Mahaveer Golechha
Davide Golinelli
Alessandra C. Goulart
Anmol Goyal
Mesay Dechasa Gudeta
Sapna Gupta
Bhawna Gupta
Awoke Derbie Habteyohannes
Dariush Haghmorad
Arvin Haj‐Mirzaian
Rabih Halwani
Demelash Woldeyohannes Handiso
Zaim Haq
Harapan Harapan
Arief Hargono
Ahmed I Hasaballah
Md Saquib Hasnain
Shoaib Hassan
Soheil Hassanipour
Omar E Hegazi
Mohammad Heidari
Kamal Hezam
Mbuzeleni Hlongwa
Nguyen Quoc Hoan
Praveen Hoogar
Mehdi Hosseinzadeh
Ahmad Hosseinzadeh Adli
Tsegaye Gebreyes Hundie
Kiavash Hushmandi
Hong-Han Huynh
Segun Emmanuel Ibitoye
Adalia Ikiroma
Kevin S Ikuta
Olayinka Stephen Ilesanmi
Irena Ilić
Arnaud Iradukunda
Mustafa Alhaji Isa
Nahlah Elkudssiah Ismail
Ihoghosa Iyamu
J Vinothini
Kathryn H. Jacobsen
Akhil Jain
Ammar Abdulrahman Jairoun
Mihajlo Jakovljević
Manthan D Janodia
Amirreza Javadi Mamaghani
Alelign Tasew Jema
Mohammad Jokar
Jost B Jonas
Nitin Joseph
Charity Ehimwenma Joshua
Ali Kabir
Md Awal Kabir
Zubair Kabir
Vidya Kadashetti
Feroze Kaliyadan
Kehinde Kazeem Kanmodi
Suthanthira Kannan S
Ibraheem M. Karaye
Arman Karimi Behnagh
Molly B Kassel
Gbenga A Kayode
Himanshu Khajuria
Nauman Khalid
Anees Ahmed Khalil
Faham Khamesipour
Gulfaraz Khan
Ejaz Ahmad Khan
Yusra Habib Khan
Mohammad Jobair Khan
Md Nuruzzaman Khan
Khaled Khatab
Feriha Fatima Khidri
Zahra Khorrami
Majid Khosravi
Jagdish Khubchandani
Min Seo Kim
Jong Yeob Kim
Yun Jin Kim
Adnan Kısa
Sezer Kısa
Somayeh Komaki
Shivakumar KM Marulasiddaiah Kondlahalli
Parvaiz A Koul
Sindhura Lakshmi Koulmane Laxminarayana
Kewal Krishan
Barthélémy Kuate Defo
Md Abdul Kuddus
Mukhtar Kulimbet
Vishnutheertha Kulkarni
Rakesh Kumar
Vijay Kumar
Nithin Kumar
Manasi Kumar
Muhammad Awwal Ladan
Dharmesh Kumar Lal
Thao T. Le
Nhi Huu Hanh Le
Seung Won Lee
Kate E LeGrand
Temesgen Leka Lerango
Ming‐Chieh Li
Virendra S Ligade
Stephen S Lim
Liknaw Workie Limenh
Xuefeng Liu
Run-Ben Liu
Rakesh Lodha
Arianna Maever Loreche
Hawraz Ibrahim M. Amin
Zheng Feei
Azeem Majeed
Elaheh Malakan Rad
Hardeep Singh Malhotra
Kashish Malhotra
Ahmad Azam Malik
Iram Malik
Tauqeer Hussain Mallhi
Mohammad Alì Mansournia
Bishnu P. Marasini
Bernardo Alfonso Martínez-Guerra
Francisco Rogerlândio Martins‐Melo
Miquel Martorell
Roy Rillera Marzo
Navgeet Mathur
Anna Laura W McKowen
Hadush Negash Meles
Endalkachew Belayneh Melese
Ziad A. Memish
Walter Mendoza
Ritesh G. Menezes
Tuomo J Meretoja
Tomislav Mestrovic
Peter Meylakhs
Laurette Mhlanga
Irmina Maria Michałek
Ana Carolina Micheletti Gomide Nogueira de Sá
Giuseppe Minervini
Le Huu Nhat Minh
Babak Moazen
Nouh Saad Mohamed
Sakineh Mohammad‐Alizadeh‐Charandabi
Abdollah Mohammadian-Hafshejani
Hussen Mohammed
Salahuddin Mohammed
Mustapha Mohammed
Ali H. Mokdad
Lorenzo Monasta
Mohammad Ali Moni
Fateme Montazeri
Maryam Moradi
Yousef Moradi
Rohith Motappa
Vincent Mougin
Sumaira Mubarik
George Duke Mukoro
Francesk Mulita
Kavita Munjal
Yanjinlkham Munkhsaikhan
B.V. Murlimanju
Fungai Musaigwa
Ghulam Mustafa
Muthupandian Saravanan
Ahamarshan Jayaraman Nagarajan
Pirouz Naghavi
Gurudatta Naik
Firzan Nainu
Mohammad Sadeq Najafi
Shumaila Nargus
Samidi Nirasha Kumari Navaratna
Muhammad Naveed
Vinod C Nayak
Biswa Prakash Nayak
Sabina O. Nduaguba
Chernet Tafere Negesse
Mohammad Hadi Nematollahi
Georges Nguefack‐Tsague
Dang Nguyen
Hien Quang Nguyen
Van Thanh Nguyen
Robina Khan Niazi
Yeshambel T. Nigatu
Nasrin Nikravangolsefid
Vikram Niranjan
Chukwudi A Nnaji
Syed Toukir Ahmed Noor
Nawsherwan Not applicable
Jean Jacques Noubiap
Chisom Adaobi Nri-Ezedi
Fred Nugen
Jerry John Nutor
Chimezie Igwegbe Nzoputam
Ogochukwu Janet Nzoputam
Kehinde Obamiro
Ismail Ayoade Odetokun
Onome Bright Oghenetega
Ayodipupo Sikiru Oguntade
Sylvester Reuben Okeke
Akinkunmi Paul Okekunle
Osaretin Christabel Okonji
Andrew T Olagunju
Babayemi O. Olakunde
Oladotun Olalusi
Matthew Idowu Olatubi
Abdulhakeem Abayomi Olorukooba
Isaac Iyinoluwa Olufadewa
Ahmed Omar Bali
Obinna Onwujekwe
Abdulahi Opejin Opejin
Michał Ordak
Verner N. Orish
Edgar Ortíz‐Brizuela
Uchechukwu Levi Osuagwu
Amel Ouyahia
Mahesh Padukudru P A
Jagadish Rao Padubidri
Claudia Palladino
Ashok Pandey
Leonidas D Panos
José Luis Paredes
Pragyan Paramita Parija
Romil R Parikh
Ava Pashaei
Maja Pasovic
Sangram Kishor Patel
Aslam Pathan
Shankargouda Patil
Shrikant Pawar
Veincent Christian Filipino Pepito
Emmanuel Peprah
Prince Peprah
Marcos Pereira
Simone Perna
Ionela-Roxana Petcu
Hoang Tran Pham
Julian David Pillay
Ramesh Poluru
Maarten J. Postma
Naeimeh Pourtaheri
Jalandhar Pradhan
Prem Prakash
Thejeswar N N Prakasham
Elton Junio Sady Prates
Dimas Ria Angga Pribadi
Tina Priscilla
Jagadeesh Puvvula
Ibrahim Qattea
Asma Saleem Qazi
Raghu Radhakrishnan
Quinn Rafferty
Ibrar Rafique
Fakher Rahim
Afarin Rahimi‐Movaghar
Vafa Rahimi‐Movaghar
Mosiur Rahman
Amir Masoud Rahmani
Shayan Rahmani
Nazanin Rahmanian
Mohammad Rahmanian
Vahid Rahmanian
Sathish Rajaa
Mahmoud M. Ramadan
Hazem Ramadan
Shakthi Kumaran Ramasamy
Pushkal Sinduvadi Ramesh
Kritika Rana
Chhabi Lal Ranabhat
Mithun Rao
Sowmya J Rao
Mohammad‐Mahdi Rashidi
Devarajan Rathish
Santosh Kumar Rauniyar
Salman Rawaf
Elrashdy M. Redwan
Robert C. Reiner
Mohsen Rezaeian
Jefferson Antonio Buendía
Kevin T. Root
Allen G. Ross
Kunle Rotimi
Nitai Roy
Godfrey Mutashambara Rwegerera
Cameron Sabet
Basema Ahmad Saddik
Mohammad Reza Saeb
Umar Saeed
Pooya Saeedi
Sher Zaman Safi
Rajesh Sagar
Fatemeh Saheb Sharif‐Askari
Narjes Saheb Sharif‐Askari
Amirhossein Sahebkar
Soumya Swaroop Sahoo
Zahra Saif
Mirza Rizwan Sajid
Nasir Salam
Afeez Abolarinwa Salami
Mohamed A. Saleh
Leili Salehi
Hossein Samadi Kafil
Abdallah M Samy
Rama Krishna Sanjeev
Milena M Santric-Milicevic
Aswini Saravanan
Benn Sartorius
Anudeep Sathyanarayan
Maheswar Satpathy
Monika Sawhney
Mansour Sedighi
Birhan Ewunu Semagn
Sabyasachi Senapati
Yashendra Sethi
Allen Seylani
Pritik A Shah
Samiah Shahid
Masood Ali Shaikh
Ali Shamekh
Mohammad Ali Shamshirgaran
Anas Shamsi
Mohd Shanawaz
Mohammed Shannawaz
Amin Sharifan
Javad Sharifi‐Rad
Shamee Shastry
Rekha R. Shenoy
Premalatha K Shetty
Mahabalesh Shetty
Pavanchand H Shetty
Desalegn Shiferaw
Reza Shirkoohi
Aminu Shittu
Sunil Shrestha
Migbar Mekonnen Sibhat
Emmanuel Edwar Siddig
Mark J. Siedner
Jasvinder A. Singh
Paramdeep Singh
Surjit Singh
Harmanjit Singh
Robert Sinto
Anna Aleksandrovna Skryabina
Amanda Smith
Farrukh Sobia
Anton Sokhan
Shipra Solanki
Ranjan Solanki
Reed J D Sorensen
Sahabi Kabir Sulaiman
Łukasz Szarpak
Sree Sudha T Y
Mohammad Tabish
Santosh Kumar Tadakamadla
Yasaman Taheri Abkenar
Jabeen Taiba
Iman M. Talaat
Mircea Tampa
Jacques Lukenze Tamuzi
Ker‐Kan Tan
Manoj Tanwar
Elvis Enowbeyang Tarkang
Nuno Taveira
Gebrehiwot Teklay
Behailu Terefe Tesfaye
Enoch Teye‐Kwadjo
Ramna Thakur
Pugazhenthan Thangaraju
Rajshree Thapa
Rekha Thapar
Friedrich Thienemann
Joe Thomas
Marcos Roberto Tovani‐Palone
Thang Huu Tran
Mai Thi Ngoc Tran
Alexander C. Tsai
Guesh Mebrahtom Tsegay
Munkhtuya Tumurkhuu
Arit Udoh
Irfan Ullah
Atta Ullah
Muhammad Umair
Muhammad Umar
Bhaskaran Unnikrishnan
Sanaz Vahdati
Asokan Govindaraj Vaithinathan
Shoban Babu Varthya
Tommi Vasankari
Georgios‐Ioannis Verras
Jorge Hugo Villafañe
Anh Vo
Theo Vos
Mandaras Tariku Walde
Richard G. Wamai
Yanzhong Wang
Muhammad Waqas
Paul Ward
Gizachew Tadesse Wassie
Robert G Weintraub
Haftom Legese Weldetinsaa
Gebre Adhanom Weldu
Ronny Westerman
Nuwan Darshana Wickramasinghe
Mesfin Agachew Woldekidan
Yen Jun Wong
Nigus Kassie Worku
Zenghong Wu
Xinsheng Wu
Sajad Yaghoubi
Gesila Endashaw Yesera
Saber Yezli
Siyan Yi
Arzu Yiğit
Dehui Yin
Yazachew Engida Yismaw
Dong Keon Yon
Naohiro Yonemoto
Fathiah Zakham
Haijun Zhang
Jingya Zhang
Hanqing Zhao
Bin Zhu
Qingyuan Zhuang
Abzal Zhumagaliuly
Magdalena Zielińska
Zihao Liu
Yossef Teshome Zikarg
Mohammad Zoladl
Alimuddin Zumla
Samer H. Zyoud
Peng Zheng
Aleksandr Y. Aravkin
Jeffrey W. Eaton
Mohsen Naghavi
Austin E Schumacher
Simon I Hay
Christopher J L Murray
Hmwe Hmwe Kyu
Date Issued
25 de noviembre de 2024
Type
Article
Volume
11
Issue
12
Start Page
e807
End Page
e822
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.
Subjects