Abstract
Background
Antiretroviral therapy (ART) scale-up in Western Europe has reduced the incidence of AIDS-related conditions, increased life expectancies, and led to an ageing population of people with HIV (PWH). We aimed to project cause-specific mortality patterns in Western Europe by 2050 in the context of changes in demographics and ART use.
Methods
We used a deterministic compartmental model calibrated in a Bayesian framework. From 2010 to 2023, the model was parameterised and calibrated using epidemiological data from European Centre for Disease Prevention and Control, UNAIDS, and the Antiretroviral Therapy Cohort Collaboration, including information on rates of cause-specific mortality by demographics and CD4 cell counts. Modelled rates from a status quo scenario, assuming the current levels of ART use were continued and compared with various scenarios where changes to ART coverage and incidence occurred from 2025-2050.
Findings
By 2050, 839,761 (95% Credible Interval: 789,451-860,875) PWH are projected to be living in Western Europe, with 90% taking ART. The percentage of PWH aged over 75 years is projected to increase from 8% in 2025 to 24% in 2050. The all-cause mortality rate is estimated to increase from 1.31 (1.25-1.36) in 2025 to 2.04 (1.95-2.12) per 100 person-years (per100py) in 2050. Between 2010 and 2025, there was an estimated decline in AIDS-related deaths of 44·2% (37·7-50·1%). From 2025-2050, projected AIDS-related mortality rates are estimated to remain constant at 0·21 per100py under a status quo scenario. During the same period, cardiovascular-related and non-AIDS-defining cancers mortality rates are estimated to increase from 0·24 (0·22-0·25) to 0·50 (0·40-0·53), and 0·31 (0.30-0·32) to 0·53 (0·50-0·56) per100py, respectively, becoming the two leading causes of death by 2050 among PWH. Over the next 25 years, if there is an increase in ART coverage (reaching 94% in 2030) and a steady decrease in HIV incidence, there would be 15,321 (14,124-16,743) fewer deaths among PWH in Western Europe.
Interpretation
Non-AIDS-related deaths are projected to increase over time due to the ageing population of PWH offsetting the AIDS-related mortality reduction. Efforts are needed to promote comprehensive care for the ageing HIV population and focus on the health needs of PWH across their lifespan.
Antiretroviral therapy (ART) scale-up in Western Europe has reduced the incidence of AIDS-related conditions, increased life expectancies, and led to an ageing population of people with HIV (PWH). We aimed to project cause-specific mortality patterns in Western Europe by 2050 in the context of changes in demographics and ART use.
Methods
We used a deterministic compartmental model calibrated in a Bayesian framework. From 2010 to 2023, the model was parameterised and calibrated using epidemiological data from European Centre for Disease Prevention and Control, UNAIDS, and the Antiretroviral Therapy Cohort Collaboration, including information on rates of cause-specific mortality by demographics and CD4 cell counts. Modelled rates from a status quo scenario, assuming the current levels of ART use were continued and compared with various scenarios where changes to ART coverage and incidence occurred from 2025-2050.
Findings
By 2050, 839,761 (95% Credible Interval: 789,451-860,875) PWH are projected to be living in Western Europe, with 90% taking ART. The percentage of PWH aged over 75 years is projected to increase from 8% in 2025 to 24% in 2050. The all-cause mortality rate is estimated to increase from 1.31 (1.25-1.36) in 2025 to 2.04 (1.95-2.12) per 100 person-years (per100py) in 2050. Between 2010 and 2025, there was an estimated decline in AIDS-related deaths of 44·2% (37·7-50·1%). From 2025-2050, projected AIDS-related mortality rates are estimated to remain constant at 0·21 per100py under a status quo scenario. During the same period, cardiovascular-related and non-AIDS-defining cancers mortality rates are estimated to increase from 0·24 (0·22-0·25) to 0·50 (0·40-0·53), and 0·31 (0.30-0·32) to 0·53 (0·50-0·56) per100py, respectively, becoming the two leading causes of death by 2050 among PWH. Over the next 25 years, if there is an increase in ART coverage (reaching 94% in 2030) and a steady decrease in HIV incidence, there would be 15,321 (14,124-16,743) fewer deaths among PWH in Western Europe.
Interpretation
Non-AIDS-related deaths are projected to increase over time due to the ageing population of PWH offsetting the AIDS-related mortality reduction. Efforts are needed to promote comprehensive care for the ageing HIV population and focus on the health needs of PWH across their lifespan.
| Original language | English |
|---|---|
| Pages (from-to) | e861-e872 |
| Number of pages | 12 |
| Journal | The Lancet HIV |
| Volume | 12 |
| Issue number | 12 |
| Early online date | 7 Nov 2025 |
| DOIs | |
| Publication status | Published - 1 Dec 2025 |
Bibliographical note
Publisher Copyright:© 2025 The Author(s). Published by Elsevier Ltd.
Research Groups and Themes
- GEM-B
Keywords
- cause-specific
- mortality rate
- ageing
- antiretroviral therapy
- high-income countries
