Trends in HIV mortality between 2001 and 2018: an observational study


BACKGROUND: Around 32.7 million people have died due to HIV since the start of the epidemic. HIV/AIDS has previously been the leading cause of death in many developed countries, subsequently gradually moving down the list. Currently it remains among the top 10 leading causes of death in low-income countries. The objective of this study was to describe current mortality rates for HIV in 48 countries.
METHODS: We extracted HIV mortality data from the WHO Mortality Database, region-wise, based on the International Classification of Diseases 10 codes. Crude mortality rates were dichotomized by gender and reported by year. We computed Age Standardized Death Rates (ASDRs) per 100,000 population using the World Standard Population. We computed mortality rates and used locally weighted scatterplot smoothing (LOWESS) plots fit to the rates of male and female mortality using SAS v9.4 (SAS, Cary, NC).
RESULTS: Out of 48 countries, 31 countries (64.6%) and 35 countries (72.9%) showed decreases in mortality in males and females, respectively. Amongst 48 countries, South Africa had the highest ASDRs for both males (467.7/100,000) and females (391.1/100,000), whereas the lowest mortalities were noted in Egypt for males (0.2/100,000) and in Japan for females (0.01/100,000). Kyrgyzstan had the greatest increase (+6998.6%) whereas Spain had greatest decease in male mortality (-81.89%). Estonia had the greatest increase (+5877.6%) whereas Australia had largest reduction in female mortality (-93.80%). Disparity in ASDR between Egypt and South-Africa was 2,338-folds for males whereas it was 39,110-folds for females between Japan and South Africa.

Squares and circles indicate ASDR/100000 for males and females respectively.
CONCLUSIONS: Although there has been a decrease in mortality attributed to HIV among most of the countries studied, a rising trend remains in a number of developing countries. A renewed and heightened commitment to address this ongoing epidemic by these countries, healthcare agencies and the global community is called for.