RESEARCH ARTICLE Trends in AIDS Deaths, New Infections and ART Coverage in the Top 30 Countries with the Highest AIDS Mortality Burden; 1990–

Background Antiretroviral therapy (ART) prevents human immunodeficiency virus (HIV) disease pro-gression, mortality and transmission. We assess the impact of expanded HIV treatment for the prevention of Acquired Immunodeficiency Syndrome (AIDS)-related deaths and simu-late 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 cover-age; 3) 90 % ART coverage based on 2013 World Health Organization (WHO) ART guide-lines by 2020; and 4) reaching the United Nations 90-90-90 Target by 2020. Findings 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 high-est death rates per 1000 people living with HIV were in Central African Republic (91), Sout