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Multicenter Study
. 2014 Sep 13;384(9947):1005-70.
doi: 10.1016/S0140-6736(14)60844-8. Epub 2014 Jul 22.

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

Christopher J L Murray  1 Katrina F Ortblad  1 Caterina Guinovart  1 Stephen S Lim  1 Timothy M Wolock  1 D Allen Roberts  1 Emily A Dansereau  1 Nicholas Graetz  1 Ryan M Barber  1 Jonathan C Brown  1 Haidong Wang  1 Herbert C Duber  1 Mohsen Naghavi  1 Daniel Dicker  1 Lalit Dandona  2 Joshua A Salomon  3 Kyle R Heuton  1 Kyle Foreman  4 David E Phillips  1 Thomas D Fleming  1 Abraham D Flaxman  1 Bryan K Phillips  1 Elizabeth K Johnson  1 Megan S Coggeshall  1 Foad Abd-Allah  5 Semaw Ferede Abera  6 Jerry P Abraham  7 Ibrahim Abubakar  8 Laith J Abu-Raddad  9 Niveen Me Abu-Rmeileh  10 Tom Achoki  11 Austine Olufemi Adeyemo  12 Arsène Kouablan Adou  13 José C Adsuar  14 Emilie Elisabet Agardh  15 Dickens Akena  16 Mazin J Al Kahbouri  17 Deena Alasfoor  17 Mohammed I Albittar  18 Gabriel Alcalá-Cerra  19 Miguel Angel Alegretti  20 Zewdie Aderaw Alemu  21 Rafael Alfonso-Cristancho  22 Samia Alhabib  23 Raghib Ali  24 Francois Alla  25 Peter J Allen  26 Ubai Alsharif  27 Elena Alvarez  28 Nelson Alvis-Guzman  29 Adansi A Amankwaa  30 Azmeraw T Amare  31 Hassan Amini  32 Walid Ammar  33 Benjamin O Anderson  22 Carl Abelardo T Antonio  34 Palwasha Anwari  35 Johan Arnlöv  36 Valentina S Arsic Arsenijevic  37 Ali Artaman  38 Rana J Asghar  39 Reza Assadi  40 Lydia S Atkins  41 Alaa Badawi  42 Kalpana Balakrishnan  43 Amitava Banerjee  44 Sanjay Basu  45 Justin Beardsley  46 Tolesa Bekele  47 Michelle L Bell  48 Eduardo Bernabe  49 Tariku Jibat Beyene  50 Neeraj Bhala  51 Ashish Bhalla  52 Zulfiqar A Bhutta  53 Aref Bin Abdulhak  54 Agnes Binagwaho  55 Jed D Blore  56 Berrak Bora Basara  57 Dipan Bose  58 Michael Brainin  59 Nicholas Breitborde  60 Carlos A Castañeda-Orjuela  61 Ferrán Catalá-López  62 Vineet K Chadha  63 Jung-Chen Chang  64 Peggy Pei-Chia Chiang  65 Ting-Wu Chuang  66 Mercedes Colomar  67 Leslie Trumbull Cooper  68 Cyrus Cooper  69 Karen J Courville  70 Benjamin C Cowie  71 Michael H Criqui  72 Rakhi Dandona  73 Anand Dayama  74 Diego De Leo  75 Louisa Degenhardt  76 Borja Del Pozo-Cruz  77 Kebede Deribe  50 Don C Des Jarlais  78 Muluken Dessalegn  79 Samath D Dharmaratne  80 Uğur Dilmen  81 Eric L Ding  82 Tim R Driscoll  83 Adnan M Durrani  84 Richard G Ellenbogen  85 Sergey Petrovich Ermakov  86 Alireza Esteghamati  87 Emerito Jose A Faraon  34 Farshad Farzadfar  88 Seyed-Mohammad Fereshtehnejad  89 Daniel Obadare Fijabi  90 Mohammad H Forouzanfar  1 Urbano Fra Paleo  14 Lynne Gaffikin  91 Amiran Gamkrelidze  92 Fortuné Gbètoho Gankpé  93 Johanna M Geleijnse  94 Bradford D Gessner  95 Katherine B Gibney  96 Ibrahim Abdelmageem Mohamed Ginawi  97 Elizabeth L Glaser  98 Philimon Gona  99 Atsushi Goto  100 Hebe N Gouda  101 Harish Chander Gugnani  102 Rajeev Gupta  103 Rahul Gupta  104 Nima Hafezi-Nejad  87 Randah Ribhi Hamadeh  105 Mouhanad Hammami  106 Graeme J Hankey  107 Hilda L Harb  33 Josep Maria Haro  108 Rasmus Havmoeller  109 Simon I Hay  24 Mohammad T Hedayati  110 Ileana B Heredia Pi  111 Hans W Hoek  112 John C Hornberger  113 H Dean Hosgood  114 Peter J Hotez  115 Damian G Hoy  116 John J Huang  48 Kim M Iburg  117 Bulat T Idrisov  118 Kaire Innos  119 Kathryn H Jacobsen  120 Panniyammakal Jeemon  121 Paul N Jensen  22 Vivekanand Jha  52 Guohong Jiang  122 Jost B Jonas  123 Knud Juel  124 Haidong Kan  125 Ida Kankindi  55 Nadim E Karam  126 André Karch  127 Corine Kakizi Karema  128 Anil Kaul  129 Norito Kawakami  130 Dhruv S Kazi  131 Andrew H Kemp  132 Andre Pascal Kengne  133 Andre Keren  134 Maia Kereselidze  92 Yousef Saleh Khader  135 Shams Eldin Ali Hassan Khalifa  136 Ejaz Ahmed Khan  137 Young-Ho Khang  138 Irma Khonelidze  92 Yohannes Kinfu  139 Jonas M Kinge  140 Luke Knibbs  101 Yoshihiro Kokubo  141 S Kosen  142 Barthelemy Kuate Defo  143 Veena S Kulkarni  144 Chanda Kulkarni  145 Kaushalendra Kumar  146 Ravi B Kumar  147 G Anil Kumar  73 Gene F Kwan  148 Taavi Lai  149 Arjun Lakshmana Balaji  56 Hilton Lam  150 Qing Lan  151 Van C Lansingh  152 Heidi J Larson  153 Anders Larsson  36 Jong-Tae Lee  154 James Leigh  155 Mall Leinsalu  119 Ricky Leung  156 Yichong Li  157 Yongmei Li  157 Graça Maria Ferreira De Lima  158 Hsien-Ho Lin  159 Steven E Lipshultz  160 Shiwei Liu  161 Yang Liu  162 Belinda K Lloyd  163 Paulo A Lotufo  132 Vasco Manuel Pedro Machado  164 Jennifer H Maclachlan  71 Carlos Magis-Rodriguez  165 Marek Majdan  166 Christopher Chabila Mapoma  167 Wagner Marcenes  168 Melvin Barrientos Marzan  169 Joseph R Masci  170 Mohammad Taufiq Mashal  171 Amanda J Mason-Jones  172 Bongani M Mayosi  173 Tasara T Mazorodze  174 Abigail Cecilia Mckay  175 Peter A Meaney  176 Man Mohan Mehndiratta  177 Fabiola Mejia-Rodriguez  111 Yohannes Adama Melaku  178 Ziad A Memish  179 Walter Mendoza  180 Ted R Miller  181 Edward J Mills  182 Karzan Abdulmuhsin Mohammad  183 Ali H Mokdad  1 Glen Liddell Mola  184 Lorenzo Monasta  185 Marcella Montico  185 Ami R Moore  186 Rintaro Mori  187 Wilkister Nyaora Moturi  188 Mitsuru Mukaigawara  189 Kinnari S Murthy  73 Aliya Naheed  190 Kovin S Naidoo  191 Luigi Naldi  192 Vinay Nangia  193 K M Venkat Narayan  162 Denis Nash  194 Chakib Nejjari  195 Robert G Nelson  196 Sudan Prasad Neupane  197 Charles R Newton  198 Marie Ng  1 Muhammad Imran Nisar  199 Sandra Nolte  27 Ole F Norheim  200 Vincent Nowaseb  201 Luke Nyakarahuka  16 In-Hwan Oh  202 Takayoshi Ohkubo  203 Bolajoko O Olusanya  204 Saad B Omer  162 John Nelson Opio  205 Orish Ebere Orisakwe  206 Jeyaraj D Pandian  207 Christina Papachristou  27 Angel J Paternina Caicedo  29 Scott B Patten  208 Vinod K Paul  209 Boris Igor Pavlin  210 Neil Pearce  153 David M Pereira  211 Aslam Pervaiz  212 Konrad Pesudovs  213 Max Petzold  214 Farshad Pourmalek  215 Dima Qato  216 Amado D Quezada  111 D Alex Quistberg  22 Anwar Rafay  217 Kazem Rahimi  24 Vafa Rahimi-Movaghar  218 Sajjad Ur Rahman  219 Murugesan Raju  220 Saleem M Rana  221 Homie Razavi  222 Robert Quentin Reilly  223 Giuseppe Remuzzi  224 Jan Hendrik Richardus  225 Luca Ronfani  185 Nobhojit Roy  226 Nsanzimana Sabin  227 Mohammad Yahya Saeedi  179 Mohammad Ali Sahraian  228 Genesis May J Samonte  229 Monika Sawhney  230 Ione J C Schneider  231 David C Schwebel  232 Soraya Seedat  233 Sadaf G Sepanlou  234 Edson E Servan-Mori  111 Sara Sheikhbahaei  87 Kenji Shibuya  235 Hwashin Hyun Shin  236 Ivy Shiue  237 Rupak Shivakoti  238 Inga Dora Sigfusdottir  239 Donald H Silberberg  240 Andrea P Silva  241 Edgar P Simard  242 Jasvinder A Singh  232 Vegard Skirbekk  140 Karen Sliwa  243 Samir Soneji  244 Sergey S Soshnikov  245 Chandrashekhar T Sreeramareddy  246 Vasiliki Kalliopi Stathopoulou  247 Konstantinos Stroumpoulis  248 Soumya Swaminathan  249 Bryan L Sykes  250 Karen M Tabb  251 Roberto Tchio Talongwa  252 Eric Yeboah Tenkorang  253 Abdullah Sulieman Terkawi  254 Alan J Thomson  255 Andrew L Thorne-Lyman  256 Jeffrey A Towbin  257 Jefferson Traebert  258 Bach X Tran  259 Zacharie Tsala Dimbuene  260 Miltiadis Tsilimbaris  261 Uche S Uchendu  262 Kingsley N Ukwaja  263 Selen Begüm Uzun  81 Andrew J Vallely  264 Tommi J Vasankari  265 N Venketasubramanian  266 Francesco S Violante  267 Vasiliy Victorovich Vlassov  268 Stein Emil Vollset  269 Stephen Waller  270 Mitchell T Wallin  271 Linhong Wang  161 XiaoRong Wang  272 Yanping Wang  273 Scott Weichenthal  236 Elisabete Weiderpass  274 Robert G Weintraub  275 Ronny Westerman  276 Richard A White  277 James D Wilkinson  278 Thomas Neil Williams  4 Solomon Meseret Woldeyohannes  279 John Q Wong  280 Gelin Xu  281 Yang C Yang  282 Yuichiro Yano  283 Gokalp Kadri Yentur  57 Paul Yip  284 Naohiro Yonemoto  285 Seok-Jun Yoon  154 Mustafa Younis  286 Chuanhua Yu  287 Kim Yun Jin  288 Maysaa El Sayed Zaki  289 Yong Zhao  290 Yingfeng Zheng  291 Maigeng Zhou  161 Jun Zhu  273 Xiao Nong Zou  292 Alan D Lopez  56 Theo Vos  1
Affiliations
Multicenter Study

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

Christopher J L Murray et al. Lancet. .

Erratum in

  • Lancet. 2014 Oct 25;384(9953):1504
  • Lancet. 2014 Sep 13;384(9947):956

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.

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Figures

Figure 1
Figure 1. UNAIDS compartmental model for estimating mortality in HIV-positive individuals in the absence of ART
ART=antiretroviral therapy.
Figure 2
Figure 2. HIV relative survival after seroconversion for male and female individuals aged 25–34 years based on the analysis of 13 ART-naive cohort studies
Solid lines show means; shaded area shows 95% uncertainty intervals (uncertainty intervals not available for UNAIDS data). ART=antiretroviral therapy.
Figure 3
Figure 3. HIV deaths in Thailand (A) and Russia (B) by age in 2005 for both sexes combined
Data are for vital registration deaths assigned to HIV (red), deaths coded to garbage codes redistributed to HIV (blue), and misclassified deaths reassigned to HIV (green). The height of the bar is the final number of deaths in each age group.
Figure 4
Figure 4. Vital registration inputs, and Spectrum and UNAIDS HIV mortality draws for Panama
Figure 5
Figure 5. Bayesian meta-regression estimates for tuberculosis prevalence (A), incidence (B), remission (C), excess mortality (D), and cause-specific mortality (E) for male individuals in Kenya, 2013
For each observation in black, the length of the horizontal bar refers to the age interval of the observation and the length of the verticle bar refers to the uncertainty interval. To stabilise estimates, all data from 2008 to 2013 are included.
Figure 6
Figure 6. Meta-analysis of published validation studies of verbal autopsy for malaria in adults (A) and children (B), both sexes combined
The solid lines show 95% uncertainty intervals (ui); the dotted lines show the point estimate of the pooled estimate (the diamond). The age cutoff for children is <15 years.
Figure 7
Figure 7. Global HIV incidence (A), prevalence (B), and mortality (C), 1990-2013, for all ages and both sexes combined
Shaded areas are 95% uncertainty intervals.
Figure 8
Figure 8. Global age-sex distribution of new HIV infections (A) and deaths (B) in 2013
Figure 9
Figure 9. Age-standardised HIV incidence (A) and prevalence (B) in 2013, both sexes
ATG=Antigua and Barbuda. VCT=Saint Vincent and the Grenadines. Isl=Islands. FSM=Federated States of Micronesia. LCA=Saint Lucia. TTO=Trinidad and Tobago. TLS=Timor-Leste.
Figure 10
Figure 10. Age-standardised HIV mortality in 2013, both sexes
ATG=Antigua and Barbuda. VCT=Saint Vincent and the Grenadines. Isl=Islands. FSM=Federated States of Micronesia. LCA=Saint Lucia. TTO=Trinidad and Tobago. TLS=Timor-Leste.
Figure 11
Figure 11. Years of life saved (YLS) through prophylactic treatment by region in 1990–2003 (A), 2004–08 (B), and 2009–13 (C), both sexes
Treatment includes antiretroviral therapy, prevention of mother-to-child transmission, and co-trimoxazole prophylaxis.
Figure 12
Figure 12. Comparison of 43 national HIV prevalence survey results for people aged 15–49 to prevalence estimates from the GBD 2013 and UNAIDS for the same year and age-group
Each point corresponds to an estimate for a particular country, survey year, sex, and 5-year age group. The solid line indicates the line of equivalence.
Figure 13
Figure 13. Global tuberculosis incidence (A), prevalence (B), and deaths (C), 1990-2013, for all ages and both sexes combined
Shaded areas show 95% uncertainty intervals.
Figure 14
Figure 14. Global age-sex distribution of tuberculosis incidence (A) and deaths (B) in HIV-negative individuals in 2013
Figure 15
Figure 15. Age-standardised tuberculosis incidence (A) and death rates (B) in HIV-negative individuals in 2013, both sexes
ATG=Antigua and Barbuda. VCT=Saint Vincent and the Grenadines. Isl=Islands. FSM=Federated States of Micronesia. LCA=Saint Lucia. TTO=Trinidad and Tobago. TLS=Timor-Leste.
Figure 16
Figure 16. Global malaria incidence (A) and deaths (B), 1990–2013, for all ages and both sexes combined
Shaded areas are 95% uncertainty intervals.
Figure 17
Figure 17. Global age-sex distribution of malaria incidence (A) and deaths (B) in 2013
Figure 18
Figure 18. Age-standardised malaria incidence (A) and death (B) rates in 2013, both sexes
ATG=Antigua and Barbuda. VCT=Saint Vincent and the Grenadines. Isl=Islands. FSM=Federated States of Micronesia. LCA=Saint Lucia. TTO=Trinidad and Tobago. TLS=Timor-Leste.

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References

    1. Institute for Health Metrics and Evaluation . Financing Global Health 2013: Transition in an Age of Austerity. IHME; Seattle, WA: 2013.
    1. Floyd K, Fitzpatrick C, Pantoja A, Raviglione M. Domestic and donor financing for tuberculosis care and control in low-income and middle-income countries: an analysis of trends, 2002-11, and requirements to meet 2015 targets. Lancet Glob Health. 2013;1:e105–15. - PubMed
    1. Creese A, Floyd K, Alban A, Guinness L. Cost-effectiveness of HIV/AIDS interventions in Africa: a systematic review of the evidence. Lancet. 2002;359:1635–43. - PubMed
    1. Vassall A, Remme M. Financing tuberculosis control: promising trends and remaining challenges. Lancet Glob Health. 2013;1:e62–63. - PubMed
    1. Hecht R, Stover J, Bollinger L, Muhib F, Case K, de Ferranti D. Financing of HIV/AIDS programme scale-up in low-income and middle-income countries, 2009-31. Lancet. 2010;376:1254–60. - PubMed

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