title: Trends in AIDS Deaths, New Infections and ART Coverage in the Top 30 Countries with the Highest AIDS Mortality Burden; 1990-2013.
abstract: BACKGROUND
  Antiretroviral therapy (ART) prevents human immunodeficiency virus (HIV) disease progression, mortality and transmission. We assess the impact of expanded HIV treatment for the prevention of Acquired Immunodeficiency Syndrome (AIDS)-related deaths and simulate four treatment scenarios for Nigeria and South Africa.
  
  
  METHODS
  For 1990-2013, we used the Joint United Nations Programme on HIV/AIDS (UNAIDS) database to examine trends in AIDS deaths, HIV incidence and prevalence, ART coverage, annual AIDS death rate, AIDS death-to-treatment and HIV infections to treatment ratios for the top 30 countries with the highest AIDS mortality burden and compare them with data from high-income countries. We projected the 1990-2020 AIDS deaths for Nigeria and South Africa using four treatment scenarios: 1) no ART; 2) maintaining current ART coverage; 3) 90% ART coverage based on 2013 World Health Organization (WHO) ART guidelines by 2020; and 4) reaching the United Nations 90-90-90 Target by 2020.
  
  
  RESULTS
  In 2013, there were 1.3 million (1.1 million-1.6 million) AIDS deaths in the top 30 countries representing 87% of global AIDS deaths. Eight countries accounted for 58% of the global AIDS deaths; Nigeria and South Africa accounted for 27% of global AIDS deaths. The highest death rates per 1000 people living with HIV were in Central African Republic (91), South Sudan (82), Côte d'Ivoire (75), Cameroon (72) and Chad (71), nearly 8-10 times higher than the high-income countries. ART access in 2013 has averted as estimated 1,051,354 and 422,448 deaths in South Africa and Nigeria, respectively. Increasing ART coverage in these two countries to meet the proposed UN 90-90-90 Target by 2020 could avert 2.2 and 1.2 million deaths, respectively.
  
  
  CONCLUSIONS
  Over the past decade the expansion of access to ART averted millions of deaths. Reaching the proposed UN 90-90-90 Target by 2020 will prevent additional morbidity, mortality and HIV transmission. Despite progress, high-burden countries will need to accelerate access to ART treatment to avert millions of premature AIDS deaths and new HIV infections.
authors.affiliation: International Association of Providers of AIDS Care, Washington D.C., United States of America.
authors.forename: Reuben
authors.initials: R
authors.lastname: Granich
authors.affiliation: International Association of Providers of AIDS Care, Washington D.C., United States of America.
authors.forename: Somya
authors.initials: S
authors.lastname: Gupta
authors.affiliation: Joint United Nations Programme on HIV/AIDS (UNAIDS), Geneva, Switzerland.
authors.forename: Bradley
authors.initials: B
authors.lastname: Hersh
authors.affiliation: Wits Reproductive Health Institute, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Brian
authors.initials: B
authors.lastname: Williams
authors.affiliation: British Columbia Centre for HIV/AIDS Excellence, Vancouver, British Columbia, Canada.
authors.forename: Julio
authors.initials: J
authors.lastname: Montaner
authors.affiliation: International Association of Providers of AIDS Care, Washington D.C., United States of America.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Young
authors.affiliation: International Association of Providers of AIDS Care, Washington D.C., United States of America.
authors.forename: José M
authors.initials: JM
authors.lastname: Zuniga
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy* / Q000401:mortality*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods; D003643:Death; D014943:Global Health; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality*; D006801:Humans; D015994:Incidence; D009549:Nigeria / Q000453:epidemiology; D015995:Prevalence; D013019:South Africa / Q000453:epidemiology; D014480:United Nations; D014944:World Health Organization