Lancet HIV. 2021 Oct;8(10):e633-e651. doi: 10.1016/S2352-3018(21)00152-1.
The sustainable development goals (SDGs) aim to end HIV/AIDS as a public health threat by 2030. Understanding the current state of the HIV epidemic and its change over time is essential to this effort. This study assesses the current sex-specific HIV burden in 204 countries and territories and measures progress in the control of the epidemic.
To estimate age-specific and sex-specific trends in 48 of 204 countries, we extended the Estimation and Projection Package Age-Sex Model to also implement the spectrum paediatric model. We used this model in cases where age and sex specific HIV-seroprevalence surveys and antenatal care-clinic sentinel surveillance data were available. For the remaining 156 of 204 locations, we developed a cohort-incidence bias adjustment to derive incidence as a function of cause-of-death data from vital registration systems. The incidence was input to a custom Spectrum model. To assess progress, we measured the percentage change in incident cases and deaths between 2010 and 2019 (threshold >75% decline), the ratio of incident cases to number of people living with HIV (incidence-to-prevalence ratio threshold <0·03), and the ratio of incident cases to deaths (incidence-to-mortality ratio threshold <1·0).
In 2019, there were 36·8 million (95% uncertainty interval [UI] 35·1-38·9) people living with HIV worldwide. There were 0·84 males (95% UI 0·78-0·91) per female living with HIV in 2019, 0·99 male infections (0·91-1·10) for every female infection, and 1·02 male deaths (0·95-1·10) per female death. Global progress in incident cases and deaths between 2010 and 2019 was driven by sub-Saharan Africa (with a 28·52% decrease in incident cases, 95% UI 19·58-35·43, and a 39·66% decrease in deaths, 36·49-42·36). Elsewhere, the incidence remained stable or increased, whereas deaths generally decreased. In 2019, the global incidence-to-prevalence ratio was 0·05 (95% UI 0·05-0·06) and the global incidence-to-mortality ratio was 1·94 (1·76-2·12). No regions met suggested thresholds for progress.
Sub-Saharan Africa had both the highest HIV burden and the greatest progress between 1990 and 2019. The number of incident cases and deaths in males and females approached parity in 2019, although there remained more females with HIV than males with HIV. Globally, the HIV epidemic is far from the UNAIDS benchmarks on progress metrics.
The Bill & Melinda Gates Foundation, the National Institute of Mental Health of the US National Institutes of Health (NIH), and the National Institute on Aging of the NIH.
可持续发展目标（SDGs）旨在到 2030 年消除艾滋病毒/艾滋病对公共卫生的威胁。了解当前艾滋病毒流行情况及其随时间的变化，对于实现这一目标至关重要。本研究评估了 204 个国家和地区目前按性别划分的艾滋病毒负担，并衡量了控制疫情的进展。
为了估计 204 个国家中的 48 个国家的年龄和性别特定趋势，我们扩展了估计和预测软件包年龄性别模型，以实施光谱小儿模型。在有年龄和性别特定艾滋病毒血清阳性率调查和产前保健门诊哨点监测数据的情况下，我们使用了该模型。对于其余 204 个地点中的 156 个地点，我们开发了一个队列发病率偏差调整，以根据来自生命登记系统的死因数据推导出发病率。发病率被输入到一个定制的光谱模型中。为了评估进展，我们衡量了 2010 年至 2019 年期间发病例和死亡例的百分比变化（阈值>75%下降）、发病例与艾滋病毒感染者人数的比值（发病例到流行率比值阈值<0.03）以及发病例与死亡例的比值（发病例到死亡率比值阈值<1.0）。
2019 年，全球有 3680 万人（95%置信区间[UI]351-389）感染艾滋病毒。2019 年，每 100 名感染艾滋病毒的女性中，有 0.84 名男性（95% UI 0.78-0.91），每 100 名女性感染艾滋病毒，就有 0.99 名男性感染艾滋病毒（0.91-1.10），每 100 名女性死亡，就有 1.02 名男性死亡（0.95-1.10）。2010 年至 2019 年期间，全球在发病例和死亡例方面的进展主要归功于撒哈拉以南非洲（发病例下降 28.52%，95% UI 19.58-35.43，死亡例下降 39.66%，36.49-42.36）。其他地区的发病率保持稳定或上升，而死亡率普遍下降。2019 年，全球发病率到流行率比值为 0.05（95% UI 0.05-0.06），全球发病率到死亡率比值为 1.94（1.76-2.12）。没有任何地区达到了进度指标的建议阈值。
撒哈拉以南非洲在 1990 年至 2019 年间拥有最高的艾滋病毒负担和最大的进展。2019 年，男性和女性的发病例和死亡例数量接近平衡，尽管感染艾滋病毒的女性仍多于男性。在全球范围内，艾滋病毒疫情远远低于艾滋病规划署在进展指标方面的基准。
比尔及梅琳达·盖茨基金会、美国国立卫生研究院（NIH）下属的美国国家心理健康研究所和 NIH 下属的国家老龄化研究所。
