London School of Hygiene & Tropical Medicine

The annual number of new HIV infections worldwide has barely declined over the past ten years, according to a major new analysis from the Global Burden of Disease (GBD) study, published in The Lancet HIV. Although the number of new infections has decreased since a peak of 3.3 million per year in 1997, the figure has stayed relatively level at around 2.5 million per year since 2005.

The findings, which are being launched at the International Aids Conference in Durban, show that between 1997-2005 the annual incidence of HIV fell by 2.7% each year, but that slowed to an average of just 0.7% from 2005 - 2015. In the past decade 74 countries including Egypt, Pakistan, Mexico, Russia and the Philippines, have even seen an increase in age-standardised rates of new infections.

The GBD study features more than 1,700 collaborators across 124 countries - including London School of Hygiene & Tropical Medicine experts -- and is co-ordinated by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, Seattle. It is the largest and most comprehensive study measuring epidemiological levels and trends worldwide.

The number of people living with HIV has been increasing steadily from 28 million in 2000 to around 39 million in 2015, largely due to the expansion of antiretroviral therapy (ART). The increase in the proportion of people living with HIV who are on ART (which has risen by 32.2% for men and 38.9% for women in the past decade) has also contributed to a decline in annual deaths from HIV/AIDS. The number of annual deaths fell by 0.6 million, from a peak of 1.8 million in 2005 to 1.2 million in 2015.

However, progress on HIV mortality has varied between regions and countries. For example, in sub-Saharan Africa, the scale-up of ART and other interventions have led to large declines in HIV-related deaths, while in many countries in Northern Africa and the Middle-East (such as Egypt, Tunisia and Morocco), there has been very little progress.

The GBD analysis showed that in 2015, three-quarters of new HIV infections (1.8 million) were in sub-Saharan Africa. Outside of Africa, south Asia accounted for 8.5% (212,500), southeast Asia for 4.7% (117,500), and east Asia for 2.3% (57,500). 

Commenting on the research, Director of the School Professor Peter Piot, who was the founding executive director of UNAIDS, said: "This study shows that the AIDS epidemic is not over by any means and that HIV/AIDS remains one of the biggest public health threats of our time.  The continuing high rate of over 2 million new HIV infections per year represents a collective failure which must be addressed through intensified prevention efforts and continued investment in HIV vaccine research."

Despite improvements in mortality and treatment numbers, many countries will struggle to reach the 90-90-90 targets set by the global community for the year 2020. These set out that 90% of everyone living with HIV will know their HIV status; 90% of those diagnosed with HIV will receive ART; 90% of people receiving ART will have viral suppression (when ART reduces an individual's viral load to an undetectable level).

Director of IHME, Prof Christopher Murray, said: "Development assistance for HIV/AIDS is stagnating and health resources in many low-income countries are expected to plateau over the next 15 years. Therefore, a massive scale-up of efforts from governments and international agencies will be required to meet the estimated $36 billion needed every year to realise the goal of ending AIDS by 2030, along with better detection and treatment programmes and improving the affordability of antiretroviral drugs."

Publication

• GBD 2015 HIV Collaborators. Estimates of global, regional, and national incidence, prevalence, and mortality of HIV, 1980-2015: the Global Burden of Disease Study 2015. The Lancet HIV. DOI: http://dx.doi.org/10.1016/S2352-3018(16)30087-X

Related links

• What will it take to end HIV? - feature
• Peter Piot writes for STAT News on why prevention must be at the forefront to meet global HIV goals

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