In 2023, globally, 39.9 million people were living with HIV and 630,000 people died from AIDS-related illnesses that same year. Recent scientific work suggests that thanks to high coverage of antiretroviral therapy, a growing share of excess mortality among people living with HIV is not linked to AIDS. A study has just taken stock of the subject.
Some figures on HIV and AIDS
Since 2010, new HIV contaminations fell by 39%, going from 2.1 million to 1.3 million in 2023. However, this figure falls far short of the 2025 target, according to the UN’s global AIDS strategy, of not exceeding 370,000 new contaminations per year.
Among the 39.9 million people living with HIV worldwide in 2023, it is estimated that 30.7 million people had access to antiretroviral therapy in 2023, or 77%. In 2010, only 7.7 million had access to this type of treatment.
To know! Antiretrovirals are medications intended to limit the multiplication of the virus in the body. Today, they generally make it possible to achieve remission in patients, that is to say control of the disease, with an undetectable viral load in the blood (the virus can remain present in certain immune cells and reactivate). Current antiretroviral treatments are triple therapieswhich combine three drugs targeting the virus.
In 2023, approximately 630,000 people died of opportunistic diseases in the world against 2.1 million in 2004 et 1.3 million in 2010. For more detail, note that AIDS-related mortality has decreased by 56% among women and girls and by 47% among men and boys since 2010.
To know! The most common opportunistic conditions are: pulmonary pneumocystosis, tuberculosis, cytomegalovirus (CMV) infections, esophageal candidiasis and then cerebral toxoplasmosis.
The 2025 target is set at less than 250,000 deaths per year.
Quantifying excess HIV-related mortality
In the strategy to reduce AIDS-related mortality, it is necessary to precisely estimate the causes of death among people living with HIV. Was their death linked to AIDS or another illness, particularly linked to aging?
Based on this observation, a team of researchers, led by Leigh Johnson from the infectious diseases research center at the University of Cape Town in South Africa, reviewed 4485 studies including people living with HIV and most of whom were on antiretroviral treatment. Among them, 8 were selected. They all came from high-income countries: five from Central and Western Europe, one from Canada, one from Japan and one from South Korea.
Their methodology? Analyze data on AIDS-related mortality rates among adults living with HIV and age-matched all-cause mortality rates among people without HIV. By comparing these data, they were able to calculate the proportion of excess mortality linked to AIDS in populations of people living with HIV.
In total, 1,331,742 years of life and 17,471 deaths from all causes were included in people living with HIV, representing a mortality rate of 13.1 per 1,000 person-years.
To know! In epidemiology, the person-year is a unit of measurement of person-time. This unit of measurement is used to calculate the incidence rate of a disease.
Among these deaths, 44% (7721) were linked to AIDS, i.e. one overall AIDS-related mortality rate of 5.8 per 1,000 person-years.
In the general population, this overall mortality rate is of 2.8 per 1,000 person-years.
By comparing these overall mortality rate data, it appears that the excess mortality attributable to AIDS is 52% in Europe Western and Central and North America compared to 71% in the Asia-Pacific region.
Against all expectations, researchers showed that almost half of the excess mortality among people living with HIV in Western regions was not linked to AIDS.
Recommendations to reduce excess HIV-related mortality
In the implications of this study, published in the Journal International Aids Society, Leigh Johnson’s team recalls that antiretrovirals undeniably reduce the share of deaths due to AIDS. However, excess mortality among people living with HIV necessarily indicates that other causes of mortality are not adequately addressed.
“Our study underlines that it is necessary to change our mentality so as to no longer consider the excess mortality of people living with HIV as being entirely due to AIDS, but rather to causes apparently unrelated to AIDS. There are multiple potential reasons why half of the excess mortality among people living with HIV in high-income countries is not AIDS-related, including that they have higher rates of comorbidities like cancer and higher consumption of psychoactive substances such as alcohol and drugs » underline the authors.
On the verge screening strategiesthe authors specify that it is necessary to strengthen them, because a high risk of comorbidities not linked to AIDS is often observed in individuals initiating their antiretroviral treatment late.
Sources
– HIV: half of excess mortality still due to AIDS in Central and Western Europe. www.lequotidiendumedecin.fr. Accessed November 25, 2024.
