Global, regional, and national burdens of HIV and syphilis in children aged 0–14 years from 1990 to 2021: a systematic analysis from the global burden of disease study 2021

This study quantified the global, regional, and national burdens of human immunodeficiency virus (HIV) and syphilis among children aged 0–14 years from 1990 to 2021 and identified key drivers of temporal changes. Age-, sex-, and region-specific prevalence and disability-adjusted life years (DALYs) were obtained from the Global Burden of Disease 2021 study as model-derived estimates. Joinpoint regression was used to assess temporal trends, and Das Gupta decomposition attributed changes in DALY counts to population growth, population ageing, and epidemiological change. From 1990 to 2021, pediatric HIV prevalence increased, particularly in middle-sociodemographic index settings and among children aged 5–14 years, whereas the HIV DALY rate declined from 236.96 to 172.55 per 100,000. This divergence is consistent with improved survival of perinatally infected cohorts under expanded antiretroviral therapy and prevention of mother-to-child transmission programmes, resulting in accumulation of prevalent cases while severe outcomes declined. Syphilis prevalence declined until 2015 and then increased, although the syphilis DALY rate fell from 450.47 to 324.68 per 100,000. Low- and middle-SDI settings and sub-Saharan African regions carried the highest absolute burdens. Epidemiological change was the predominant contributor to DALY changes in most settings. HIV and syphilis remain major threats to child health, underscoring the need for strengthened prevention of mother-to-child transmission, early diagnosis, and integrated pediatric services.