Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2017 Mar;4(3):e113-e121.
doi: 10.1016/S2352-3018(16)30225-9. Epub 2016 Dec 10.

Trends in the burden of HIV mortality after roll-out of antiretroviral therapy in KwaZulu-Natal, South Africa: an observational community cohort study

Georges Reniers  1 , Sylvia Blom  2 , Clara Calvert  2 , Alexandra Martin-Onraet  3 , Abraham J Herbst  4 , Jeffrey W Eaton  5 , Jacob Bor  6 , Emma Slaymaker  2 , Zehang R Li  7 , Samuel J Clark  8 , Till Bärnighausen  9 , Basia Zaba  2 , Victoria Hosegood  10
Affiliations
Observational Study

Trends in the burden of HIV mortality after roll-out of antiretroviral therapy in KwaZulu-Natal, South Africa: an observational community cohort study

Georges Reniers et al. Lancet HIV. 2017 Mar.

Abstract

Background: Antiretroviral therapy (ART) substantially decreases morbidity and mortality in people living with HIV. In this study, we describe population-level trends in the adult life expectancy and trends in the residual burden of HIV mortality after the roll-out of a public sector ART programme in KwaZulu-Natal, South Africa, one of the populations with the most severe HIV epidemics in the world.

Methods: Data come from the Africa Centre Demographic Information System (ACDIS), an observational community cohort study in the uMkhanyakude district in northern KwaZulu-Natal, South Africa. We used non-parametric survival analysis methods to estimate gains in the population-wide life expectancy at age 15 years since the introduction of ART, and the shortfall of the population-wide adult life expectancy compared with that of the HIV-negative population (ie, the life expectancy deficit). Life expectancy gains and deficits were further disaggregated by age and cause of death with demographic decomposition methods.

Findings: Covering the calendar years 2001 through to 2014, we obtained information on 93 903 adults who jointly contribute 535 42 8 person-years of observation to the analyses and 9992 deaths. Since the roll-out of ART in 2004, adult life expectancy increased by 15·2 years for men (95% CI 12·4-17·8) and 17·2 years for women (14·5-20·2). Reductions in pulmonary tuberculosis and HIV-related mortality account for 79·7% of the total life expectancy gains in men (8·4 adult life-years), and 90·7% in women (12·8 adult life-years). For men, 9·5% is the result of a decline in external injuries. By 2014, the life expectancy deficit had decreased to 1·2 years for men (-2·9 to 5·8) and to 5·3 years for women (2·6-7·8). In 2011-14, pulmonary tuberculosis and HIV were responsible for 84·9% of the life expectancy deficit in men and 80·8% in women.

Interpretation: The burden of HIV on adult mortality in this population is rapidly shrinking, but remains large for women, despite their better engagement with HIV-care services. Gains in adult life-years lived as well as the present life expectancy deficit are almost exclusively due to differences in mortality attributed to HIV and pulmonary tuberculosis.

Funding: Wellcome Trust, the Bill & Melinda Gates Foundation, and the National Institutes of Health.

PubMed Disclaimer

Figures

Figure 1
Figure 1. Adult LE trends by sex and HIV status, and the LE deficit (uMkhanyakude, 2001-'14)
Figure 2
Figure 2. Age and cause-group contributions to the gross LE gains between 2001-'04 and 2011-'14, by sex (uMkhanyakude)
Figure 3
Figure 3. Age-cause decomposition of the LE deficit in 2007-'10 and 2011-'14, by sex (uMkhanyakude)
See this image and copyright information in PMC

Comment in

References

    1. Reniers G, Slaymaker E, Nakiyingi-Miiro J, et al. Mortality trends in the era of antiretroviral therapy: evidence from the Network for Analysing Longitudinal Population based HIV/AIDS data on Africa (ALPHA) AIDS. 2014;28 Suppl 4:S533–42. - PMC - PubMed
    1. Herbst AJ, Mafojane T, Newell ML. Verbal autopsy-based cause-specific mortality trends in rural KwaZulu-Natal, South Africa, 2000-2009. Popul Health Metr. 2011;9:47. - PMC - PubMed
    1. Jahn A, Floyd S, Crampin AC, et al. Population-level effect of HIV on adult mortality and early evidence of reversal after introduction of antiretroviral therapy in Malawi. Lancet. 2008;371(9624):1603–11. - PMC - PubMed
    1. Johnson LF, Mossong J, Dorrington RE, et al. Life expectancies of South African adults starting antiretroviral treatment: collaborative analysis of cohort studies. PLoS Med. 2013;10(4):e1001418. - PMC - PubMed
    1. Mills EJ, Bakanda C, Birungi J, et al. Life expectancy of persons receiving combination antiretroviral therapy in low-income countries: a cohort analysis from Uganda. Ann Intern Med. 2011;155(4):209–16. - PubMed

Publication types