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HIV to be top health problem within 25 years

November 28, 2006 By Michael Hopkin This article courtesy of Nature News.

AIDS set to become world's biggest problem disease.

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AIDS will become the world's most burdensome disease by 2030, according to predictions released today. Its predicted rise, which will overtake today's top problem of poor perinatal health (such as low birth weight), is being blamed on many countries' failure to impose proper prevention measures since the pandemic was first revealed.

The result is in sharp contrast to the same group's last prediction, made in 1996, that heart disease would be the top global health problem in 2020, with HIV a mere tenth in the list.

"HIV is not going to come down unless we invest more in prevention efforts," says Colin Mathers, one of the researchers at the Geneva-based World Health Organization, who produced the prediction. Even if rates of HIV infection remain constant, growing populations in the developing world will propel it to the top of the rankings at a time when rates of other communicable diseases are set to improve.

According to the report, issued as part of the Global Burden of Disease project, and published in PLoS Medicine1, by 2030 AIDS could account for almost one in every eight years of life lost through death or disability.

Other infectious diseases, however, are set to decrease as control measures improve.

Malaria, diarrhoea and tuberculosis are all due to fall off the top ten list. The bad news is that this spells a relative growth in smoking-related disease, cancer and road injuries.

Wishful thinking

The figures were compiled through examining social and economic trends over the past 50 years, and extrapolating them into the future. To allow comparison, the impacts of different diseases are calculated according to their overall burden the effects they have through death and through harming quality of life by causing illness or disability.

So although AIDS is not predicted to be the world's biggest killer by 2030 that will be heart disease it is likely to be the most burdensome, the report says (see Box). Overall, cases are expected to rise from 2.8 million worldwide in 2002, to 6.5 million in 2030.

The 1996 report was too ready to hope that countries would control the spread of HIV, and did not factor in the explosion of infections in sub-Saharan Africa, Mathers says. "In 1996 we were much more optimistic that the world would take up prevention methods," he says. "But over the past decade, apart from a few countries, efforts have not been made to address prevention."

Up in smokers

Of the roughly 73 million deaths expected to occur during the year 2030, some 69% are predicted to be caused by non-communicable disease, such as cancer, compared with roughly 60% today.

Many of these trends are now inevitable, says Mathers. Ageing populations, and the ever-growing number of smokers, means that the expected rise in cancer has already had its seeds sown. "It's a bit more than just guesswork," he says.

But some trends might still be averted, he adds. The figures assume that current trends of disease management will continue into the future, but the report also includes more optimistic and pessimistic scenarios. Wider provision of anti-HIV drugs, for example, could mean that those already infected are less likely to pass it on. "If governments do ramp up their anti-HIV efforts, it could start to decrease," says Mathers.

The predicted rise of clinical depression will be a product of declines in other, more preventable, diseases, Mathers says. In high-income countries, it is expected to account for almost 10% of all disease burden by 2030. The same goes for road injuries under the report's 'optimistic' scenario, traffic accidents replaces heart disease in the top three.

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  1. Mathers C. D. &Loncar D. PLoS Med., e442 doi:10.1371/journal.pmed.0030442 (2006).


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