Trends in incidence of HIV/AIDS
Globally, the incident number of HIV/AIDS increased 28.62% since 1990. During the period 1990-2004, the overall age-standardized incidence rate (ASIR) of HIV/AIDS was relatively stable (Table 1, and Figure 1A). Compared to males, females had higher incident number in 2004 (1434.95×103) (Table 1). The highest incident number was observed in the age group of 25 to 29 years (487.92×103) and under 5 years (408.96×103) in 2004, and the largest increasing percent in number occurred in those aged under 5 years (124.05%) (eTable 1and eFigure 1A in the Additional file). Pronounced decreasing trend was observed in low SDI area (EAPC = −5.43, 95%CI: −5.97 to −4.89), but increasing one occured in middle SDI area (EAPC = 7.21, 95%CI: 4.03 to 10.49). At regional level, increasing trend of HIV/AIDS were observed in 11 regions, particularly Oceania and Eastern Europe, with the respective EAPCs were 27.38 (95%CI: 18.38 to 37.07) and 12.94 (95%CI: 9.97 to 15.99). Conversely, decreasing trends were seen in 8 regions, and the highest decreasing one was Eastern Sub-Saharan Africa (EAPC = −6.10, 95% CI: −6.79 to −5.40), followed by Central Sub-Saharan Africa and Caribbean (Table 1, and eFigure 1B-C in the Additional file). At the national level, increasing trends of HIV/AIDS were observed in 104 countries/territories, especially Nepal, Estonia and Lao People's Democratic Republic, in which the respective EAPCs were 48.02 (95%CI: 37.33 to 59.55), 42.80 (95%CI: 39.60 to 46.08) and 36.94 (95%CI: 32.01 to 42.04). On the other hand, decreasing trends were seen in 61 countries/territories, and the most pronounced ones occurred in Burundi and Spain, with the respective EAPCs were −13.92 (95%CI: −14.61 to −13.21) and −13.51 (95%CI: −16.10 to −10.84) (Figure 2A, and eTable 3, eFigure 5A and 7A in the Additional file).
The incident number of HIV/AIDS declined 22.77% during the period 2005-2019, and it was 1989.28×103 (95%UI: 1760.91×103 to 2259.35×103) in 2019. The ASIR decreased by an annual average of 2.68% (EAPC = −2.68, 95%CI: −2.82 to −2.53) (Table 1, and Figure 1B). From 2005-2019, a decreasing trend in ASIR of HIV/AIDS was more obvious in females than that of males, with the EAPC of − 3.14 (95%CI: − 3.30 to − 2.98) (Table 1). Among age groups, the highest increase in number of HIV/AIDS cases was observed in age group above 60 years (19.83%), and the highest decrease was in group aged under 5 years (−67.8%) (eTable 2 and eFigure 1A in the Additional file).Downward trend of ASIR were observed in low, low-middle, and middle SDI areas, particularly the first one (EAPC = −5.29, 95%CI: −5.61 to −4.98). However, increasing trends were seen in high-middle and high SDI areas. At regional level, the trends declined in 8 geographic regions, and the largest ones were seen in Eastern Sub-Saharan Africa and East Asia, with the respective EAPCs were −5.66 (95%CI: −5.97 to −5.35) and −5.35 (95%CI: −6.31 to −4.37). However, increasing trends occured in 13 geographic regions, particularly Eastern Europe (EAPC= 12.31, 95%CI: 10.38 to 14.28) (Table 1, and eFigure 1B-C in the Additional file). Among 204 countries/territories, the ASIR presented downward trends in 72 countries, and the largest one was in Burundi (EAPC = −12.93, 95%CI: −13.23 to −12.63), followed by Cambodia and Democratic Republic of the Congo. On the other hand, the ASIR showed increasing trends in 100 countries, particularly Kazakhstan (EAPC = 13.00, 95%CI: 11.52 to 14.50), followed by Russian Federation and Ukraine (Figure 3A, and eTable 3, eFigure 6A and 8A in the Additional file).
Trends in prevalence of HIV/AIDS
From 1990 to 2004, the number of HIV/AIDS prevalence increased 258.90%, and the ASR showed a significant upward trend globally, with the EAPC was 7.47 (95%CI: 5.84 to 9.12) (Figure 1A, and eTable 4 in the Additional file). Compared with the males, females had more prevalence number and pronounced increasing trend, in which the EAPC of 8.06 (95%CI: 6.23 to 9.91) (eTable 4 in the Additional file). Percentages in prevalence number of HIV/AIDS increased in all age groups, particular the group of 10-14 (15030.00%) (eTable 1 and eFigure 2A in the Additional file). Increasing trends of prevalence occurred in most SDI areas and geographic regions, particularly Oceania and South Asia, in which the respective EAPCs were 39.48 (95%CI: 34.22 to 44.95) and 25.27 (95%CI: 19.18 to 31.68) (eTable 4 and eFigure 2B-C in the Additional file). With regard to national level, from 1990 to 2004, the rising trends were observed in 179 countries/territories, and the largest one was Nepal (EAPC = 64.97, 95%CI: 52.41 to 78.57), followed by Papua New Guinea and Lao People's Democratic Republic. However, the trends of prevalence decreased only in 13 countries/territories, particularly Burkina Faso (EAPC = −6.21, 95%CI: −6.93 to −5.50) (Figure 2B, and eTable 5, eFigure 5B and 7B in the Additional file).
Globally, the prevalence number of HIV/AIDS increased 30.31% from 2005 to 2019, and it was 36848.15×103 (95% UI: 35149.00×103 to 38856.67×103) in 2019. Increasing trend of HIV/AIDS prevalence was demonstrated with a EAPC of 0.71 (95% CI: 0.54 to 0.87) (Figure 1B, and eTable 4 in the Additional file). During 2005 and 2019, the ASR in prevalence of HIV/AIDS showed increasing trends in both sexes, especially female (EAPC = 0.76, 95%CI: 0.58 to 0.94) (eTable 4 in the Additional file). During the period 2005-2019, percentages in prevalence number of HIV/AIDS increased in most age group, particularly the group of >80 (263.55%), while the largest decreasing was in those aged <5 years (−55.79%) (eTable 3 and eFigure 2A in the Additional file). Trends of prevalence declined in low and low-middle SDI areas, but increased in other areas, particularly High-middle one (EAPC = 4.42, 95%CI: 3.78 to 5.06). The upward trends of prevalence occured in most regions, especially Eastern Europe and Central Asia, in which the EAPCs were 11.81 (95%CI: 11.00 to 12.62) and 5.96 (95%CI: 5.13 to 6.81) (eTable 4 and eFigure 2B-C in the Additional file). Among 204 countries/territories, decreasing trends of prevalence were observed in 44 countries from 2005 to 2019, particularly Sao Tome and Principe (EAPC = −6.98, 95%CI: −8.23 to −5.71), followed by Burundi and Somalia. While the rising trends occurred in 157 countries, and the largest ones were in Georgia, Armenia, and Russian Federation, with the EAPCs were 17.14 (95%CI: 14.11 to 20.25), 15.49 (95%CI: 14.33 to 16.67), and 14.88 (95%CI: 14.29 to 15.47) (Figure 3B, and eTable 5, eFigure 6B and 8B in the Additional file).
Trends in death of HIV/AIDS
The age-standardized death rate (ASDR) of HIV/AIDS had a rising trend worldwide from 1990 to 2004 (EAPC = 10.85, 95%CI: 8.90 to 12.84) (Figure 1A, and eTable 6 in the Additional file). Compared with the males, females had more death number and pronounced increasing trend, in which the EAPC of 11.89 (95%CI: 9.76 to 14.06) (eTable 6 in the Additional file). During the period 1990-2004, percentages in death number of HIV/AIDS increased in all age groups, particular the group of 10-14 (3480.81%) (eTable 1,and eFigure 3A in the Additional file). Increasing trends of ASDR occurred in most SDI areas and regions, except high SDI area (EAPC = −9.09, 95%CI: −11.88 to −6.20). The most pronounced increasing trends were found in Oceania and South Asia, in which the respective EAPCs were 44.76 (95%CI: 40.81 to 48.82) and 40.82 (95%CI: 34.31 to 47.64) (eTable 6, and eFigure 3B-C in the Additional file). At national level, decreasing trends were documented in 28 countries/territories from 1990 to 2004, and the largest ones were in New Zealand (EAPC = −12.99, 95%CI: −14.98 to −10.96), followed by France and Australia. On the other hand, increasing trends in ASDR were observed in 157 countries, particularly Nepal (EAPC = 95.37, 95%CI: 76.31 to 116.49), followed by Lao People's Democratic Republic and Papua New Guinea (Figure 2C and eTable 7, eFigure 5C and 7C in the Additional file).
During the period 2005-2019, the death number of HIV/AIDS decreased 52.89%, and it was 863.84×103(95% UI: 786.07×103 to 996.04×103) worldwide in 2019. Globally, the ASDR showed an obvious downward trend from 2005 to 2019, with the EAPC was −6.73 (95%CI: −6.98 to −6.47) (Figure 1B, and eTable 6 in the Additional file). Decreasing trends of HIV/AIDS were observed in both sexes ( eTable 6 in the Additional file). In age groups, percentages in death number of HIV/AIDS decreased in all age groups, except for aged >80 years (0.01%). The highest decreasing percentage changes occurred in those aged <5 years (−76.53%) (eTable 2 and eFigure 3A in the Additional file). The ASDR had downward trends in all SDI areas and most regions, and the largest decreasing trends were seen in South Asia (EAPC = −11.20, 95%CI: −12.03 to −10.36), followed by Eastern Sub-Saharan Africa and Southern Sub-Saharan Africa. Whereas increasing trends were observed in East Asia, Eastern Europe and North Africa and Middle East (eTable 6 and eFigure 3B-C in the Additional file). At the national level, decreasing trends were seen in 128 countries/territories, particularly Burundi, Malawi, and Zimbabwe, with the respective EAPCs were −15.28 (95%CI: −16.08 to −14.47), −13.51 (95%CI: −14.15 to −12.87), and −13.34 (95%CI: −14.31 to −12.35). Conversely, increasing trends occurred in 45 countries/territories, and the most pronounced ones were in Georgia and United Arab Emirates, in which the respective EAPCs were 28.87 (95%CI: 18.33 to 40.35) and 16.60 (95%CI: 14.66 to 18.57) (Figure 3C, and eTable 7, eFigure 6C and 8C in the Additional file).
Trends in DALYs caused by HIV/AIDS
Pronounced increasing trend was observed in DALYs caused by HIV/AIDS from 1990 to 2004, with an EAPC was 10.40 (95%CI: 8.47 to 12.36). During the period 1990-2004, increasing trends of DALYs occurred in males and females (Figure 1A, and eTable 8 in the Additional file). The DALYs number of HIV/AIDS increased in all age groups, particular those aged 10-14 (3587.85%) (eTable 1 and eFigure 4A in the Additional file). Increasing trends of DALYs occurred in most SDI areas and regions, particularly Oceania and South Asia, in which the EAPCs were 43.06 (95%CI: 39.14 to 47.09) and 37.95 (95%CI: 32.07 to 44.10). Whereas decreasing trends were seen in high SDI area and other regions, and the largest ones were observed in Australasia (EAPC = −12.30, 95%CI: −14.98 to −9.53), followed by High-income North America and Western Europe (eTable 8 and eFigure 4B-C in the Additional file). At national level, increasing trends of DALYs were observed in 158 countries/territories, with the most pronounced one being in Nepal (EAPC= 86.23, 95%CI: 69.87 to 104.17), followed by Papua New Guinea and Lao People's Democratic Republic. However, decreasing trends were seen in 28 countries, particularly France and Australia, with the respective EAPCs were −12.60 (95%CI: −15.93 to −9.14) and −12.32 (95%CI: −15.17 to −9.38) (Figure 2D, and eTable 9, eFigure 5D and 7D in the Additional file).
Globally, the number of DALYs due to HIV/AIDS was 47632.18×103 (95%UI: 42630.99×103 to 55650.04×103) in 2019, with a decrease of 54.03% since 2005. The ASR of DALYs had a decreasing trend worldwide from 2005 to 2019 (EAPC = −6.75, 95%CI: −6.95 to −6.54) (Figure 1B, and eTable 8 in the Additional file). Compared with the males, females had higher decreasing trend, in which the EAPC of −7.44 (95%CI: −7.65 to −7.22) (eTable 8 in the Additional file). During the period 2005-2019, percentages in DALYs number of HIV/AIDS decreased in all age groups, except for aged >80 years (19.37%) (eTable 2 and eFigure 4A in the Additional file). Meanwhile, downward trends of DALYs were observed in all SDI areas and most regions, and the largest decreasing ones were observed in South Asia and Eastern Sub-Saharan Africa, in which the EAPCs were −10.99 (95%CI: −11.75 to −10.22) and −9.45 (95%CI: −9.69 to −9.20), respectively (eTable 8 and eFigure 4B-C in the Additional file). At national level, decreasing trends were observed in 127 countries/territories, particularly Burundi (EAPC = −15.07, 95%CI: −15.79 to −14.33). Conversely, increasing trends occurred in 46 countries/territories, and the largest ones were seen in Georgia (EAPC= 24.30, 95%CI: 15.87 to 33.34), followed by Pakistan and Micronesia (Figure 3D, and eTable 9, eFigure 6D and 8D in the Additional file).
Analysis on the influential factors of EAPC
During the period 1990-2004, EAPCs had negative associations with the ASR in 2004 in incidence, prevalence of HIV/AIDS (ρ = −0.28, p <0.001; ρ = −0.17, p =0.018, respectively). On the other hand, EAPCs had negative associations with the HDI in 2004 in prevalence, death, and DALYs of HIV/AIDS (ρ = −0.25, p <0.001; ρ = −0.49, p <0.001; ρ = −0.51, p <0.001, respectively).
During the period 2005-2019, EAPCs had negative associations with the ASR in 2005 in incidence, prevalence, death, and DALYs of HIV/AIDS (ρ = −0.38, p <0.001; ρ = −0.25, p <0.001; ρ = −0.37, p <0.001; and ρ = −0.40, p <0.001, respectively) (Figure 4A-D). Whereas EAPCs had positive associations with the HDI in 2019 in incidence, prevalence, death, and DALYs of HIV/AIDS (ρ = 0.50, p <0.001; ρ = 0.43, p <0.001; ρ = 0.28, p <0.001; and ρ = 0.34, p <0.001, respectively) (Figure 5A-D).