Global burden of the HIV epidemic
Authors: TC Quinn
Journal: The Lancet (1996)

Author's reply Sir—The statement in the first paragraph of my review that Steward cites should have read “AIDS is one of the leading causes of death in major cities in the USA, Europe, and sub-Saharan Africa”. This introductory statement was further qualified in the first paragraph of the section on the demographic and economic impact of HIV infection. There I state that in some urban centres of sub-Saharan Africa, western Europe, and the Americas, AIDS has become the leading cause of death for both men and women aged 15–49 years. Several previous publications readily support this state for the USA and sub-Saharan Africa.1CDCUpdate: mortality attributable to HIV infection among persons aged 25–44 years—United States, 1994.MMWR Morbid Mortal Wkly Rep. 1996; 45: 121-143PubMed Google Scholar, 2Mulder DW Nunn AJ Kamali A Nakiyingi J Wagner HU Kengeya-Kayonodo JF Two-year HIV-1-associated mortality in a Ugandan rural population.Lancet. 1994; 343: 1021-1023Summary PubMed Scopus (126) Google Scholar* For western Europe several recent reports further substantiate the increasing impact of the AIDS mortality in this young adult age group. In a comparative demographic analysis of patterns of HIV/AIDS mortality in industrialised countries, the mortality rate due to AIDS in individuals between 25 and 44 years of age was particularly high in the USA, Spain, and France.3Yip B Hogg RS Frank O et al.Comparative demographic analysis of patterns of HIV/AIDS mortality in industrialised nations. Abstract No. Mo.C.1544, IXth International Conference on AIDS, VancouverJuly 7–12, 1996Google Scholar In Italy in 1992, AIDS was the second cause of death within people aged 25–34 years, and ranked first in the three northern regions of Italy.4Conti S Farchi G Galletti A Masocco M Rezza G AIDS: a major health problem among young Italian women. Abstract No. Tu.C.2454, IXth International Conference on AIDS, VancouverJuly 7–12, 1996Google Scholar In Catalonia, Spain, AIDS was the second leading cause of death in people aged 20–39 in 1991 and was projected to be the leading cause of death by 1994.5Casabona BJ Blanch MC Vall Mayans M Salvador VX Premature mortality related to AIDS among men and women in Catalonia.AIDS. 1993; 7: 1099-1103Crossref PubMed Scopus (13) Google Scholar These mortality rates focus on the young adult population since most HIV infections occur during these years, and because AIDS-related morbidity and mortality mainly affects people during their economically productive adult years when they are often responsible for the support and care of others. Because of these increased mortality rates, the 1993 World Development Report identified HIV infection as one of the leading causes of disability-adjusted life-years lost. It is evident that the overall demographic and economic ramifications of AIDS fatalities will continue to rise and will reach far into the future. Global burden of the HIV epidemicIn the opening paragraph of his review, Quinn (July 13, p 99)1 describes AIDS as “the leading cause of death in major cities in the USA, Europe, and sub-Saharan Africa”. This is an outrageous inaccuracy. Even if it seems to be so in some cities in the USA and African countries, there are no data, official returns, or other evidence that it has happened or is happening in any of the main cities, or indeed anywhere in the UK. It would be surprising if the main cities of other countries in Europe are different. Full-Text PDF