Trends of HIV Mortality between 2001 and 2018: An Observational Analysis

Since the beginning of the epidemic in the early 1980s, HIV-related illnesses have led to the deaths of over 32.7 million individuals. The objective of this study was to describe current mortality rates for HIV through an observational analysis of HIV mortality data from 2001 to 2018 from the World Health Organization (WHO) Mortality Database. We computed age-standardized death rates (ASDRs) per 100,000 people using the World Standard Population. We plotted trends using locally weighted scatterplot smoothing (LOWESS). Data for females were available for 42 countries. In total, 31/48 (64.60%) and 25/42 (59.52%) countries showed decreases in mortality in males and females, respectively. South Africa had the highest ASDRs for both males (467.7/100,000) and females (391.1/100,000). 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 in mortality for males (+6998.6%). Estonia had the greatest increase in mortality for females (+5877.56%). The disparity between Egypt (the lowest) and South Africa (the highest) was 3042-fold for males. Between Japan and South Africa, the disparity was 43,454-fold for females. Although there was a decrease in mortality attributed to HIV among most of the countries studied, a rising trend remained in a number of developing countries.

Dynamic Predictions From Longitudinal CD4 Count Measures And Time To Death of HIV/AIDS Patients Using a Bayesian Joint Model

Background: Personalised or stratified medicine has played an increasingly important role in improving bio-medical care in recent years. A Bayesian joint modelling approach to dynamic prediction of HIV progression and mortality allows such individualised predictions to be made for HIV patients, based on monitoring of their CD4 counts. This study aims to provide predictions of patient-specific trajectories of HIV disease progression and survival.Methods: Longitudinal data on 254 HIV/AIDS patients who received ART between 2009 and 2014, and who had at least one CD4 count observed, were employed in a Bayesian joint model of disease progression, as measured by CD4 counts, and survival, to obtain individualised dynamic predictions of both processes that were updated at each visit time in the follow-up period. Different forms of association structure that relate the longitudinal CD4 biomarker and time to death were assessed; and predictions were averaged over the different models using Bayesian model averaging.Results: A total of 254 subjects were observed in the dataset with a median age of 30 years (interquartile range, IQR, 26–38). The individual follow-up times ranged from 1 to 120 months, with a median of 22 months and IQR 7 -39 months. The median baseline CD4 count was 129 cells/mm3 (IQR 61–247 cells/mm3). From the joint model with highest posterior weight, subjects whose functional status was working were significantly associated with a higher baseline CD4 count (β = 1.86; 95% CI: 0.65 3.04) whereas subjects who were bedridden were significantly associated with a lower baseline CD4 count (estimated effect β = -3.54; 95% CI: -5.65, -1.39), compared to ambulatory patients. A unit increase in weight of the individual increased the mean square root CD4 measurement by 0.06. The estimates of the association structure parameters from all three models considered indicated that the HIV mortality hazard at any time point is associated with the current underlying value of the CD4 count at the same time point. The model with highest posterior weight also had a time-dependent slope, indicating that HIV mortality is also associated with the rate of change in CD4 count. From both the model-averaged predictions and the highest posterior weight model alone, an increase in CD4 count was predicted at different visit times from the dynamic predictions. It was also found that there was an increase in the width of prediction intervals as time progressed.Conclusions: Functional status, weight and alcohol intake are important contributing factors that affect the mean square root of CD4 measurements. For this particular dataset, model averaging the dynamic predictions resulted in only one of the hypothesised association structures having non-zero weight at the majority of time points for each individual. The predictions were therefore similar whether we averaged them over models or derived them from the highest posterior weight model alone. We also observed that the parameter estimates in the both the CD4 count and survival sub-models showed slight variability between the postulated association structures.

Age, Period and Cohort Analysis of Young Adult Mortality due to HIV and TB in South Africa: 1997-2015

Background: Young adult mortality is very significant in South Africa due to the influence of HIV/AIDS, Tuberculosis (TB), Injuries and Non-Communicable Diseases (NCDs). Previous analyses have mainly focused on assessing the time effect of age and period separately. However, health outcomes often depend on three-time scales, namely age, period, and cohort, which are linearly interlinked. Using Age-Period-Cohort (APC) models, this study estimated the time effects of age, period, and cohort on HIV and TB mortality among young adults in South Africa. Methods: HIV and TB mortality data and mid population estimates were obtained from Statistics South Africa for the period 1997 to 2015. Mortality data are based on deaths reported to the Department of Home Affairs where the underlying cause of death was HIV or TB based on the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) definition. Observed HIV/AIDS deaths were adjusted for under-reporting, misclassification, and systematic proportion from ill-defined natural deaths. Three-year age, period, and birth cohort intervals for 15-64 years, 1997-2015 and 1934-2000 respectively were used. The Age-Period-Cohort (APC) analysis using the Poisson distribution was used to compute the effects of age, period, and cohort on mortality due to TB and HIV. Results: A total of 5, 825,502 adult deaths were recorded from the period 1997 to 2015 of which, 910,731 (15.6%) and 252,101 (4.3%) were attributed to TB and HIV, respectively. For both observed mortality rate and estimated relative effects, concave down associations were found between TB, HIV mortality rates and period, age with peaks, at 36-38 and 30-32 years, respectively. A downward trend and inverted V-shape between TB and HIV mortality by birth cohort was found, respectively. Conclusions: The study found an inverse U-shaped association between TB-related mortality and age, period, and general downward trend with a birth cohort for deaths reported between 1997 and 2015. A concave down relationship between HIV-related mortality and age, period, and inverted V-shaped with birth cohort was found. Our findings have shed more light on HIV and TB mortality rates across different age groups, the effect of changes in the overall TB and HIV management and care on the mortality rates, and whether the mortality rates depend on the year an individual was born.

Mapping subnational HIV mortality in six Latin American countries with incomplete vital registration systems

Background Human immunodeficiency virus (HIV) remains a public health priority in Latin America. While the burden of HIV is historically concentrated in urban areas and high-risk groups, subnational estimates that cover multiple countries and years are missing. This paucity is partially due to incomplete vital registration (VR) systems and statistical challenges related to estimating mortality rates in areas with low numbers of HIV deaths. In this analysis, we address this gap and provide novel estimates of the HIV mortality rate and the number of HIV deaths by age group, sex, and municipality in Brazil, Colombia, Costa Rica, Ecuador, Guatemala, and Mexico. Methods We performed an ecological study using VR data ranging from 2000 to 2017, dependent on individual country data availability. We modeled HIV mortality using a Bayesian spatially explicit mixed-effects regression model that incorporates prior information on VR completeness. We calibrated our results to the Global Burden of Disease Study 2017. Results All countries displayed over a 40-fold difference in HIV mortality between municipalities with the highest and lowest age-standardized HIV mortality rate in the last year of study for men, and over a 20-fold difference for women. Despite decreases in national HIV mortality in all countries—apart from Ecuador—across the period of study, we found broad variation in relative changes in HIV mortality at the municipality level and increasing relative inequality over time in all countries. In all six countries included in this analysis, 50% or more HIV deaths were concentrated in fewer than 10% of municipalities in the latest year of study. In addition, national age patterns reflected shifts in mortality to older age groups—the median age group among decedents ranged from 30 to 45 years of age at the municipality level in Brazil, Colombia, and Mexico in 2017. Conclusions Our subnational estimates of HIV mortality revealed significant spatial variation and diverging local trends in HIV mortality over time and by age. This analysis provides a framework for incorporating data and uncertainty from incomplete VR systems and can help guide more geographically precise public health intervention to support HIV-related care and reduce HIV-related deaths.

Gender features of mortality from HIV infection

The aim of the study is to establish the gender characteristics of mortality from HIV infection, as well as to identify the socio-demographic context of the more negative dynamics of mortality among women. We used data from the official statistics on mortality from Rosstat, as well as information from the information system on deaths in Moscow (RFS-UMIAS), which is based on data from medical death certificates issued by medical organizations of the Moscow Department of Health. It was found that the sources of more negative dynamics of female mortality are not related to their socio-demographic status, but are determined by other factors. The socio-demographic portrait of those who died from HIV is gender neutral, showing no significant differences between men and women in terms of education, or the frequency of unemployment, or the prevalence of loneliness due to lack of family. The regional vector of HIV mortality in men and women also coincides.

20-years dynamics of tuberculosis and HIV mortality and of their contribution to life expectancy reduction in the population of Krasnoyarsk

Aim of the study. To study the dynamics of mortality from tuberculosis and HIV as well as their contribution to life expectancy reduction in Krasnoyarsk Krai population over a period of 20 years. Material and methods. We used primary databases of Krasnoyarsk Krai population mortality for the period from 1999 to 2018. The direct method of standardisation according to the European standard of population age structure was applied for calculation of the standardised population mortality ratio. In order to analyse mortality in the population of the WHO European region and the CIS, the data of the European health information gateway were used (https://gateway.euro.who.int). Results. It has been established that female mortality from certain infectious and parasitic diseases has increased signifi cantly (from 13.2 to 22.7 per 100,000 of female population) in the cause of death structure of Krasnoyarsk Krai within the 20-years period. Analysis of Krasnoyarsk Krai mortality from such specifi c conditions as tuberculosis and HIV has shown signifi cant decrease in tuberculosis mortality rate which complies with the global trend in the dynamics of mortality from this disease, while the rate of reduction for this index surpasses that of CIS countries. Th e analysis has established signifi cant growth of HIV mortality in Krasnoyarsk Krai population, especially female (up to 11.6 per 100,000 of female population). Conclusion. There has been a change of the leading mortality cause in the structure of population mortality from certain infectious and parasitic diseases over the period of 2016-2017. From that moment, the leading role in the cause of death structure of Krasnoyarsk Krai in this class of causes belongs to HIV

Young Adult Age-Period-Cohort Analysis of HIV and TB Mortality in South Africa: 1997-2015

Background: Young adult mortality is very significant in South Africa due to the influence of HIV/AIDS, Tuberculosis (TB), Injuries and Non-Communicable Diseases (NCDs). Previous analyses have mainly focused on assessing time effect of age and period separately. However, health outcomes often depend on three-time scales of age, period and cohort, which are linearly interlinked. Using Age-Period-Cohort (APC) models, this study estimated the time effects of age, period and cohort on HIV and TB mortality among young adults in South Africa.Methods: HIV and TB mortality data and mid population estimates were obtained from Statistics South Africa for the period 1997 to 2015. Mortality data are based on deaths reported to the Department of Home Affairs where the underlying cause of death was HIV or TB based on the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) definition. Observed HIV/AIDS deaths were adjusted for under-reporting, misclassification and systematic proportion from ill-defined natural deaths. Three-year age, period, and birth cohort intervals for 15–64 years, 1997–2015 and 1934–2000 respectively were used. The Age-Period-Cohort (APC) analysis using the Poisson distribution was used to compute the effects of age, period and cohort on mortality due to TB and HIV.Results: A total of 5, 825,502 adult deaths were recorded from the period 1997 to 2015 of which, 910,731 (15.6%) and 252,101 (4.3%) were attributed to TB and HIV, respectively. For both observed mortality rate and estimated relative effects, concave down associations were found between TB, HIV mortality rates and period, age with peaks, at 36–38 and 30–32 years, respectively. A downward trend and inverted V-shape between TB and HIV mortality by birth cohort was found, respectively.Conclusions: The study found an inverse U-shaped association between TB-related mortality and age, period, and general downward trend with birth cohort for deaths reported between 1997 and 2015. A concave down relationship between HIV-related mortality and age, period, and inverted V-shaped with birth cohort was found. Our findings have shed more light on HIV and TB mortality rates across different age groups, effect of changes in the overall TB and HIV management and care on the mortality rates and whether or not the mortality rates depended on the year an individual was born.