Deaths and infections from HIV and tuberculosis decline sharply in US

HIV/AIDS deaths dropped from a peak of more than 40,000 in 1995 to around 10,000 in 2013, and TB deaths declined at a rate of 3.7% since 2000. New TB cases are declining faster than the global average, but new HIV/AIDS cases are increasing.

SEATTLE—Today, fewer people are dying from HIV/AIDS and tuberculosis in the United States, according to a new, first-of-its kind analysis of trend data from 188 countries. But while globally the pace of decline in HIV deaths has accelerated since 2000, when the Millennium Development Goals (MDGs) were established to stop the spread of these diseases by 2015, in the United States, the rate of decline in HIV/AIDS deaths has slowed down.

Published in The Lancet on July 22, the 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,” was conducted by an international consortium of researchers led by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington.

To help people understand the findings, IHME released a new Millennium Development Goals Visualization that allows people to compare and contrast progress achieved among 188 countries in meeting each of the health-related MDGs.

Globally, HIV/AIDS and tuberculosis kill fewer people than they have in the past, and declines in new cases and deaths from these diseases have accelerated since 2000. Worldwide, deaths from HIV/AIDS declined at a rate of 1.5% between 2000 and 2013, while tuberculosis deaths declined at a rate of 3.7%.

Deaths from HIV/AIDS in the United States decreased by an annualized rate of 2.8% between 2000 and 2013, faster than the global average of 1.5%, and far slower than the 10.2% decline in deaths from 1990 to 2000. Deaths from tuberculosis unrelated to HIV infection dropped at a slightly faster rate (4%) than the global average (3.7%) between 2000 and 2013.

After adjusting for differences in population size and ages across time, the researchers found that 10 out of every 100,000 people in the United States were living with tuberculosis in 2013. In the country, there were approximately five new cases of tuberculosis per 100,000 people in 2013. In comparison, 145 out of every 100,000 people in the US were infected with HIV/AIDS and there were eight new infections per 100,000 in 2013.

In the United States, new cases of HIV and deaths from the disease were primarily concentrated in males. In 2013, there were 7,694 deaths from HIV in males compared to 2,503 in women. For tuberculosis in the United States, there were 630 deaths in males and 403 in females in 2013. Similarly, new cases and deaths from HIV and tuberculosis are more common in males at the global level.

At 2.9 per 100,000, death rates from HIV/AIDS in the United States were far lower than the global average of 18.5 per 100,000. For comparison, the death rate from HIV/AIDS in Mexico was higher at 3 per 100,000 but far lower in the United Kingdom at 0.34 per 100,000.

“The United States was one of the first countries to address HIV/AIDS through a range of programs, and it saw rapid declines in mortality after the peak of the epidemic in the mid-1990s,” said Dr. Christopher Murray, IHME Director and one of the study’s authors. “But we know we can do better. With more than 25,000 people becoming infected with the disease in 2013, we know that efforts to stop the spread of HIV/AIDS still are falling short.”

Researchers found that greater access to treatment is needed as well. Globally, in 2013, there were nearly 30 million people living with HIV, 1.8 million new infections, and 1.3 million deaths from the disease. At the peak of the epidemic in 2005, HIV caused 1.7 million deaths. Global HIV incidence peaked in 1997 with 2.8 million new infections and has declined since the peak at 2.7% per year.

The study reveals substantial changes to previous understanding of HIV epidemics. In Latin America and Eastern Europe, HIV epidemics are substantially smaller than previously estimated – while in some countries, like the Philippines, the crisis is actually much bigger.

This updated analysis shows some notable differences when compared to the GBD 2010 study, and new estimates were found to be lower than previous estimates. Estimated HIV deaths in Latin American countries such as Peru, Venezuela, and Colombia were reduced by more than two-thirds in 2010. In the same year, the population of people living with HIV in Eastern and Central Europe was found to be over 60% smaller than previously estimated, highlighted by a 69% decrease in Russia.

Improvements in IHME’s methodology revealed that cumulatively, countries identified as having concentrated epidemics had 39% fewer deaths and 53% fewer people living with HIV. In contrast, deaths in countries with generalized epidemics increased by 23%, and the HIV-infected populations were slightly higher by 3%.

With progress in reducing HIV at the global level, success in particular countries and regions varies as the HIV epidemic has peaked and declined at different times.

Regionally, the burden of HIV is concentrated in sub-Saharan Africa. Prevalence levels are highest in Botswana, Lesotho, and Swaziland (above 12,000 per 100,000 people). HIV rates in Botswana, for example, are 15 times higher than in the Democratic Republic of the Congo (DRC) and 40 times higher than in Niger.

Researchers found similar variation in other regions. In Southeast Asia, HIV rates are substantially higher in Thailand and Papua New Guinea. HIV rates are relatively high in parts of Europe and Central Asia (Portugal, Spain, Ukraine, Russia, and Kazakhstan) and in Latin America and the Caribbean (Panama, Honduras, Belize, Guatemala, Guyana, Suriname, Haiti, Dominican Republic, Jamaica, and the Bahamas) where prevalence levels exceed 220 per 100,000.

“The global investment in HIV treatment is saving lives at a rapid clip,” Dr. Murray said. “But the quality of antiretroviral programs varies widely. In order to reduce HIV-related deaths even further, we need to learn from the best programs and do away with the worst ones.”

“The gains made in these three important MDG 6 targets are quite exciting. It will be especially interesting to see if the development of additional control tools such as new drugs and vaccines might accelerate the progress seen to date,” said Dr. Peter Hotez, Dean of the National School of Tropical Medicine at Baylor College of Medicine and Texas Children’s Hospital.

Earlier and more effective treatment has also helped shorten the duration of TB infections worldwide.

However, the authors note that aging of the population will lead to higher numbers of cases and deaths. In both the United States and at the global level, the bulk of tuberculosis deaths tend to occur in older age groups.

TB rates globally have declined between 2000 and 2013 due largely to progress in two regions: East and South Asia. In South Asia, which accounts for almost half of TB deaths, mortality rates declined annually by 4.2% during this period.  In East Asia, death rates fell annually by 7.5%.

When looking at death rates that are age-standardized, meaning they were adjusted for differences in population size and ages over time and across countries, the highest rates for TB are in east and central sub-Saharan Africa (Lesotho, Somalia, and Burundi all had over 150 deaths per 100,000 in 2013).

The Institute for Health Metrics and Evaluation (IHME) is an independent global health research organization at the University of Washington that provides rigorous and comparable measurement of the world’s most important health problems and evaluates the strategies used to address them. IHME makes this information widely available so that policymakers have the evidence they need to make informed decisions about how to allocate resources to best improve population health.

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