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ABSTRACT

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 occurred 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 generalized epidemics, we minimized a loss function to select epidemic curves most consistent with prevalence data and demographic data for all-cause mortality. We analyzed counterfactual scenarios for HIV to assess years of life saved through prevention of mother-to-child transmission (PMTCT) and ART. For tuberculosis, we analyzed vital registration and verbal autopsy data to estimate mortality using cause of death ensemble modeling. We analyzed 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 analyzed malaria mortality and incidence using an updated cause of death database, a systematic analysis of verbal autopsy validation studies for malaria, and recent studies (2010–2013) of incidence, drug resistance, and coverage of insecticide-treated bed nets.

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$4,498 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). Annualized 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.

Citation: 

Murray CJL‡, Ortblad KF, Guinovart C, Lim SS, Wolock TM, Roberts DA, Dansereau EA, Graetz N, Barber RM, Brown JC, Wang H, Duber HC, Naghavi M, Dicker D, Dandona L, Salomon JA, Heuton KR, Foreman K, Phillips DE, Fleming TD, Flaxman AD, Phillips BK, Johnson EK, Coggeshall MS, Abd-Allah F*, Abera SF*, Abraham JP*, Abubakar I*, Abu-Raddad LJ*, Abu-Rmeileh NM*, Achoki T*, Adeyemo AO*, Adou AK*, Adsuar JC*, Agardh EE*, Akena D*, Al Kahbouri MJ*, Alasfoor D*, Albittar MI*, Alcalá-Cerra G*, Alegretti MA*, Alemu ZA*, Alfonso-Cristancho R*, Alhabib S*, Ali R*, Alla F*, Allen PJ*, Alsharif U*, Alvarez E*, Alvis-Guzman N*, Amankwaa AA*, Amare AT*, Amini H*, Ammar W*, Anderson BO*, Antonio CAT*, Anwari P*, Ärnlöv J*, Arsenijevic VSA*, Artaman A*, Asghar RJ*, Assadi R*, Atkins LS*, Badawi A*, Balakrishnan K*, Banerjee A*, Basu S*, Beardsley J*, Bekele T*, Bell ML*, Bernabe E*, Beyene TJ*, Bhala N*, Bhalla A*, Bhutta ZA*, Bin Abdulhak A*, Binagwaho A, Blore J*, Bora Basara B*, Bose D*, Brainin M*, Breitborde N*, Castañeda-Orjuela CA*, Catalá-López F*, Chadha VK*, Chang J-C*, Chiang PP-C*, Chuang T-W*, Colomar M*, Cooper LT*, Cooper C*, Courville KJ*, Cowie BC*, Criqui MH*, Dandona R*, Dayama A*, De Leo D*, Degenhardt L*, Del Pozo-Cruz* B, Deribe K*, Des Jarlais DC*, Dessalegn M*, Dharmaratne SD*, Dilmen U*, Ding EL*, Driscoll TR*, Durrani AM*, Ellenbogen RG*, Ermakov SP*, Esteghamati A*, Faraon EJA*, Farzadfar F*, Fereshtehnejad S*, Fijabi DO*, Forouzanfar MH*, Fra.Paleo U*, Gaffikin L*, Gamkrelidze A*, Gankpé FG*, Geleijnse JM*, Gessner BD*, Gibney KB*, Ginawi IAM*, Glaser EL*, Gona P*, Goto A*, Gouda HN*, Gugnani HC*, Gupta R*, Gupta R*, Hafezi-Nejad N*, Hamadeh RR*, Hammami M*, Hankey GJ*, Harb HL*, Haro JM*, Havmoeller R*, Hay SI*, Hedayati MT*, Heredia Pi IB*, Hoek HW*, Hornberger JC*, Hosgood HD*, Hotez PJ*, Hoy DG*, Huang JJ*, Iburg KM*, Idrisov BT*, Innos K*, Jacobsen KH*, Jeemon P*, Jensen PN*, Jha V*, Jiang G*, Jonas JB*, Juel K*, Kan H*, Kankindi I*, Karam NE*, Karch A*, Karema CK*, Kaul A*, Kawakami N*, Kazi DS*, Kemp AH*, Kengne AP*, Keren A*, Kereselidze M*, Khader YS*, Khalifa SEAH*, Khan EA*, Khang Y-H*, Khonelidze I*, Kinfu Y*, Kinge JM*, Knibbs L*, Kokubo Y*, Kosen S*, Kuate Defo B*, Kulkarni VS*, Kulkarni C*, Kumar K*, Kumar RB*, Kumar GA*, Kwan GF*, Lai T*, Lakshmana Balaji A*, Lam H*, Lan Q*, Lansingh VC*, Larson HJ*, Larsson A*, Lee J-T*, Leigh J*, Leinsalu M*, Leung R*, Li Y*, Li Y*, De Lima GMF*, Lin H-H*, Lipshultz SE*, Liu S*, Liu Y*, Lloyd BK*, Lotufo PA*, Machado VMP*, Maclachlan JH*, Magis-Rodriguez C*, Majdan M*, Mapoma CC*, Marcenes W*, Marzan MB*, Masci JR*, Mashal MT*, Mason-Jones AJ*, Mayosi BM*, Mazorodze TT*, Mckay AC*, Meaney PA*, Mehndiratta MM*, Mejia-Rodriguez F*, Melaku YA*, Memish ZA*, Mendoza W*, Miller TR*, Mills EJ*, Mohammad KA*, Mokdad A*, Mola GL*, Monasta L*, Montico M*, Moore AR*, Mori R*, Moturi WN*, Mukaigawara M*, Murthy KS*, Naheed A*, Naidoo KS*, Naldi L*, Nangia V*, Narayan KMV*, Nash D*, Nejjari C*, Nelson RG*, Neupane SP*, Newton CR*, Ng M*, Nisar MI*, Nolte S*, Norheim OF*, Nowaseb V*, Nyakarahuka L*, Oh I-H*, Takayoshi Ohkubo T*, Olusanya BO*, Omer SB*, Opio JN*, Orisakwe EO*, Pandian JD*, Papachristou C*, Paternina Caicedo AJ*, Patten SB*, Paul VK*, Pavlin BI*, Pearce N*, Pereira DM*, Pervaiz A*, Pesudovs K*, Petzold M*, Pourmalek F*, Qato D*, Quezada AD*, Quistberg DA*, Rafay A*, Rahimi K*, Rahimi-Movaghar V*, Rahman SU*, Raju M*, Rana SM*, Razavi H*, Reilly RQ*, Remuzzi G*, Richardus JH*, Ronfani L*, Roy N*, Sabin N*, Saeedi MY*, Sahraian MA*, Samonte GMJ*, Sawhney M*, Schneider IJC*, Schwebel DC*, Seedat S*, Sepanlou SG*, Servan-Mori EE*, Sheikhbahaei S, Shibuya K*, Shin HH*, Shiue I*, Shivakoti R*, Sigfusdottir ID*, Silberberg DH*, Silva AP*, Simard EP*, Singh JA*, Skirbekk V*, Sliwa K*, Soneji S*, Soshnikov SS*, Sreeramareddy CT*, Stathopoulou VK*, Stroumpoulis K*, Swaminathan S*, Sykes BL*, Tabb KM*, Talongwa RT*, Tenkorang EY*, Terkawi AS*, Thomson AJ*, Thorne-Lyman AL*, Towbin JA*, Traebert J*, Tran BX*, Tsala Dimbuene Z*, Tsilimbaris M*, Uchendu US*, Ukwaja KN*, Uzun SB*, Vallely AJ*, Vasankari TJ*, Venketasubramanian N*, Violante FS*, Vlassov VV*, Waller S*, Wallin MT*, Wang L*, Wang SX*, Wang Y*, Weichenthal S*, Weiderpass E*, Weintraub RG*, Westerman R*, White RA*, Wilkinson JD*, Williams TN*, Woldeyohannes SM*, Wong JQ*, Xu G*, Yang YC*, Yano Y*, Yentur GK*, Yip P*, Yonemoto N*, Yoon S*, Younis M*, Yu C*, Jin KY*, Zaki MES*, Zhao Y*, Zheng Y*, Zhou M*, Zhu J*, Zou XN*, Lopez A†, Vos T†. 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. The Lancet. 2014 July 23. doi: 10.1016/S0140-6736(14)60844-8

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