Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.

Abstract

BACKGROUND:

The Millennium Declaration in 2000 brought special global attention to HIV, tuberculosis, and malaria through the formulation of Millennium Development Goal (MDG) 6. The Global Burden of Disease 2013 study provides a consistent and comprehensive approach to disease estimation for between 1990 and 2013, and an opportunity to assess whether accelerated progress has occured since the Millennium Declaration.

METHODS:

To estimate incidence and mortality for HIV, we used the UNAIDS Spectrum model appropriately modified based on a systematic review of available studies of mortality with and without antiretroviral therapy (ART). For concentrated epidemics, we calibrated Spectrum models to fit vital registration data corrected for misclassification of HIV deaths. In generalised epidemics, we minimised a loss function to select epidemic curves most consistent with prevalence data and demographic data for all-cause mortality. We analysed counterfactual scenarios for HIV to assess years of life saved through prevention of mother-to-child transmission (PMTCT) and ART. For tuberculosis, we analysed vital registration and verbal autopsy data to estimate mortality using cause of death ensemble modelling. We analysed data for corrected case-notifications, expert opinions on the case-detection rate, prevalence surveys, and estimated cause-specific mortality using Bayesian meta-regression to generate consistent trends in all parameters. We analysed malaria mortality and incidence using an updated cause of death database, a systematic analysis of verbal autopsy validation studies for malaria, and recent studies (2010-13) of incidence, drug resistance, and coverage of insecticide-treated bednets.

FINDINGS:

Globally in 2013, there were 1·8 million new HIV infections (95% uncertainty interval 1·7 million to 2·1 million), 29·2 million prevalent HIV cases (28·1 to 31·7), and 1·3 million HIV deaths (1·3 to 1·5). At the peak of the epidemic in 2005, HIV caused 1·7 million deaths (1·6 million to 1·9 million). Concentrated epidemics in Latin America and eastern Europe are substantially smaller than previously estimated. Through interventions including PMTCT and ART, 19·1 million life-years (16·6 million to 21·5 million) have been saved, 70·3% (65·4 to 76·1) in developing countries. From 2000 to 2011, the ratio of development assistance for health for HIV to years of life saved through intervention was US$4498 in developing countries. Including in HIV-positive individuals, all-form tuberculosis incidence was 7·5 million (7·4 million to 7·7 million), prevalence was 11·9 million (11·6 million to 12·2 million), and number of deaths was 1·4 million (1·3 million to 1·5 million) in 2013. In the same year and in only individuals who were HIV-negative, all-form tuberculosis incidence was 7·1 million (6·9 million to 7·3 million), prevalence was 11·2 million (10·8 million to 11·6 million), and number of deaths was 1·3 million (1·2 million to 1·4 million). Annualised rates of change (ARC) for incidence, prevalence, and death became negative after 2000. Tuberculosis in HIV-negative individuals disproportionately occurs in men and boys (versus women and girls); 64·0% of cases (63·6 to 64·3) and 64·7% of deaths (60·8 to 70·3). Globally, malaria cases and deaths grew rapidly from 1990 reaching a peak of 232 million cases (143 million to 387 million) in 2003 and 1·2 million deaths (1·1 million to 1·4 million) in 2004. Since 2004, child deaths from malaria in sub-Saharan Africa have decreased by 31·5% (15·7 to 44·1). Outside of Africa, malaria mortality has been steadily decreasing since 1990.

INTERPRETATION:

Our estimates of the number of people living with HIV are 18·7% smaller than UNAIDS's estimates in 2012. The number of people living with malaria is larger than estimated by WHO. The number of people living with HIV, tuberculosis, or malaria have all decreased since 2000. At the global level, upward trends for malaria and HIV deaths have been reversed and declines in tuberculosis deaths have accelerated. 101 countries (74 of which are developing) still have increasing HIV incidence. Substantial progress since the Millennium Declaration is an encouraging sign of the effect of global action.

FUNDING:

Bill & Melinda Gates Foundation.

• Authors: Christopher J L Murray, Katrina F Ortblad, Caterina Guinovart, Stephen S Lim, Timothy M Wolock, D Allen Roberts, Emily A Dansereau, Nicholas Graetz, Ryan M Barber, Jonathan C Brown, Haidong Wang, Herbert C Duber, Mohsen Naghavi, Daniel Dicker, Lalit Dandona, Joshua A Salomon, Kyle R Heuton, Kyle Foreman, David E Phillips, Thomas D Fleming, Abraham D Flaxman, Bryan K Phillips, Elizabeth K Johnson, Megan S Coggeshall, Foad Abd-Allah, Semaw Ferede Abera, Jerry P Abraham, Ibrahim Abubakar, Laith J Abu-Raddad, Niveen Me Abu-Rmeileh, Tom Achoki, Austine Olufemi Adeyemo, Arsène Kouablan Adou, José C Adsuar, Emilie Elisabet Agardh, Dickens Akena, Mazin J Al Kahbouri, Deena Alasfoor, Mohammed I Albittar, Gabriel Alcalá-Cerra, Miguel Angel Alegretti, Zewdie Aderaw Alemu, Rafael Alfonso-Cristancho, Samia Alhabib, Raghib Ali, Francois Alla, Peter J Allen, Ubai Alsharif, Elena Alvarez, Nelson Alvis-Guzman, Adansi A Amankwaa, Azmeraw T Amare, Hassan Amini, Walid Ammar, Benjamin O Anderson, Carl Abelardo T Antonio, Palwasha Anwari, Johan Arnlöv, Valentina S Arsic Arsenijevic, Ali Artaman, Rana J Asghar, Reza Assadi, Lydia S Atkins, Alaa Badawi, Kalpana Balakrishnan, Amitava Banerjee, Sanjay Basu, Justin Beardsley, Tolesa Bekele, Michelle L Bell, Eduardo Bernabe, Tariku Jibat Beyene, Neeraj Bhala, Ashish Bhalla, Zulfiqar A Bhutta, Aref Bin Abdulhak, Agnes Binagwaho, Jed D Blore, Berrak Bora Basara, Dipan Bose, Michael Brainin, Nicholas Breitborde, Carlos A Castañeda-Orjuela, Ferrán Catalá-López, Vineet K Chadha, Jung-Chen Chang, Peggy Pei-Chia Chiang, Ting-Wu Chuang, Mercedes Colomar, Leslie Trumbull Cooper, Cyrus Cooper, Karen J Courville, Benjamin C Cowie, Michael H Criqui, Rakhi Dandona, Anand Dayama, Diego De Leo, Louisa Degenhardt, Borja Del Pozo-Cruz, Kebede Deribe, Don C Des Jarlais, Muluken Dessalegn, Samath D Dharmaratne, Uğur Dilmen, Eric L Ding, Tim R Driscoll, Adnan M Durrani, Richard G Ellenbogen, Sergey Petrovich Ermakov, Alireza Esteghamati, Emerito Jose A Faraon, Farshad Farzadfar, Seyed-Mohammad Fereshtehnejad, Daniel Obadare Fijabi, Mohammad H Forouzanfar, Urbano Fra Paleo, Lynne Gaffikin, Amiran Gamkrelidze, Fortuné Gbètoho Gankpé, Johanna M Geleijnse, Bradford D Gessner, Katherine B Gibney, Ibrahim Abdelmageem Mohamed Ginawi, Elizabeth L Glaser, Philimon Gona, Atsushi Goto, Hebe N Gouda, Harish Chander Gugnani, Rajeev Gupta, Rahul Gupta, Nima Hafezi-Nejad, Randah Ribhi Hamadeh, Mouhanad Hammami, Graeme J Hankey, Hilda L Harb, Josep Maria Haro, Rasmus Havmoeller, Simon I Hay, Mohammad T Hedayati, Ileana B Heredia Pi, Hans W Hoek, John C Hornberger, H Dean Hosgood, Peter J Hotez, Damian G Hoy, John J Huang, Kim M Iburg, Bulat T Idrisov, Kaire Innos, Kathryn H Jacobsen, Panniyammakal Jeemon, Paul N Jensen, Vivekanand Jha, Guohong Jiang, Jost B Jonas, Knud Juel, Haidong Kan, Ida Kankindi, Nadim E Karam, André Karch, Corine Kakizi Karema, Anil Kaul, Norito Kawakami, Dhruv S Kazi, Andrew H Kemp, Andre Pascal Kengne, Andre Keren, Maia Kereselidze, Yousef Saleh Khader, Shams Eldin Ali Hassan Khalifa, Ejaz Ahmed Khan, Young-Ho Khang, Irma Khonelidze, Yohannes Kinfu, Jonas M Kinge, Luke Knibbs, Yoshihiro Kokubo, S Kosen, Barthelemy Kuate Defo, Veena S Kulkarni, Chanda Kulkarni, Kaushalendra Kumar, Ravi B Kumar, G Anil Kumar, Gene F Kwan, Taavi Lai, Arjun Lakshmana Balaji, Hilton Lam, Qing Lan, Van C Lansingh, Heidi J Larson, Anders Larsson, Jong-Tae Lee, James Leigh, Mall Leinsalu, Ricky Leung, Yichong Li, Yongmei Li, Graça Maria Ferreira De Lima, Hsien-Ho Lin, Steven E Lipshultz, Shiwei Liu, Yang Liu, Belinda K Lloyd, Paulo A Lotufo, Vasco Manuel Pedro Machado, Jennifer H Maclachlan, Carlos Magis-Rodriguez, Marek Majdan, Christopher Chabila Mapoma, Wagner Marcenes, Melvin Barrientos Marzan, Joseph R Masci, Mohammad Taufiq Mashal, Amanda J Mason-Jones, Bongani M Mayosi, Tasara T Mazorodze, Abigail Cecilia Mckay, Peter A Meaney, Man Mohan Mehndiratta, Fabiola Mejia-Rodriguez, Yohannes Adama Melaku, Ziad A Memish, Walter Mendoza, Ted R Miller, Edward J Mills, Karzan Abdulmuhsin Mohammad, Ali H Mokdad, Glen Liddell Mola, Lorenzo Monasta, Marcella Montico, Ami R Moore, Rintaro Mori, Wilkister Nyaora Moturi, Mitsuru Mukaigawara, Kinnari S Murthy, Aliya Naheed, Kovin S Naidoo, Luigi Naldi, Vinay Nangia, K M Venkat Narayan, Denis Nash, Chakib Nejjari, Robert G Nelson, Sudan Prasad Neupane, Charles R Newton, Marie Ng, Muhammad Imran Nisar, Sandra Nolte, Ole F Norheim, Vincent Nowaseb, Luke Nyakarahuka, In-Hwan Oh, Takayoshi Ohkubo, Bolajoko O Olusanya, Saad B Omer, John Nelson Opio, Orish Ebere Orisakwe, Jeyaraj D Pandian, Christina Papachristou, Angel J Paternina Caicedo, Scott B Patten, Vinod K Paul, Boris Igor Pavlin, Neil Pearce, David M Pereira, Aslam Pervaiz, Konrad Pesudovs, Max Petzold, Farshad Pourmalek, Dima Qato, Amado D Quezada, D Alex Quistberg, Anwar Rafay, Kazem Rahimi, Vafa Rahimi-Movaghar, Sajjad Ur Rahman, Murugesan Raju, Saleem M Rana, Homie Razavi, Robert Quentin Reilly, Giuseppe Remuzzi, Jan Hendrik Richardus, Luca Ronfani, Nobhojit Roy, Nsanzimana Sabin, Mohammad Yahya Saeedi, Mohammad Ali Sahraian, Genesis May J Samonte, Monika Sawhney, Ione J C Schneider, David C Schwebel, Soraya Seedat, Sadaf G Sepanlou, Edson E Servan-Mori, Sara Sheikhbahaei, Kenji Shibuya, Hwashin Hyun Shin, Ivy Shiue, Rupak Shivakoti, Inga Dora Sigfusdottir, Donald H Silberberg, Andrea P Silva, Edgar P Simard, Jasvinder A Singh, Vegard Skirbekk, Karen Sliwa, Samir Soneji, Sergey S Soshnikov, Chandrashekhar T Sreeramareddy, Vasiliki Kalliopi Stathopoulou, Konstantinos Stroumpoulis, Soumya Swaminathan, Bryan L Sykes, Karen M Tabb, Roberto Tchio Talongwa, Eric Yeboah Tenkorang, Abdullah Sulieman Terkawi, Alan J Thomson, Andrew L Thorne-Lyman, Jeffrey A Towbin, Jefferson Traebert, Bach X Tran, Zacharie Tsala Dimbuene, Miltiadis Tsilimbaris, Uche S Uchendu, Kingsley N Ukwaja, Selen Begüm Uzun, Andrew J Vallely, Tommi J Vasankari, N Venketasubramanian, Francesco S Violante, Vasiliy Victorovich Vlassov, Stein Emil Vollset, Stephen Waller, Mitchell T Wallin, Linhong Wang, XiaoRong Wang, Yanping Wang, Scott Weichenthal, Elisabete Weiderpass, Robert G Weintraub, Ronny Westerman, Richard A White, James D Wilkinson, Thomas Neil Williams, Solomon Meseret Woldeyohannes, John Q Wong, Gelin Xu, Yang C Yang, Yuichiro Yano, Gokalp Kadri Yentur, Paul Yip, Naohiro Yonemoto, Seok-Jun Yoon, Mustafa Younis, Chuanhua Yu, Kim Yun Jin, Maysaa El Sayed Zaki, Yong Zhao, Yingfeng Zheng, Maigeng Zhou, Jun Zhu, Xiao Nong Zou, Alan D Lopez, Theo Vos
• Journal: Lancet (London, England) (Lancet) Vol. 384 Issue 9947 Pg. 1005-70 (Sep 13 2014) ISSN: 1474-547X [Electronic] England
• PMID: 25059949 (Publication Type: Journal Article, Multicenter Study, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, P.H.S.)
• Copyright: Copyright © 2014 Elsevier Ltd. All rights reserved.

Topics

• Age Distribution
• Epidemics (statistics & numerical data)
• Female
• Global Health (trends)
• HIV Infections (epidemiology)
• Humans
• Incidence
• Malaria (epidemiology)
• Male
• Mortality (trends)
• Organizational Objectives
• Sex Distribution
• Tuberculosis (epidemiology)