Salim S. Abdool Karim, MD, PhD reviewing Reniers G et al. Lancet HIV 2016 Dec 9.

Following the roll-out of antiretroviral therapy in a rural South African community, tuberculosis and HIV-related mortality declined, and life expectancy increased.

Several reports have demonstrated that antiretroviral therapy (ART) substantially decreases morbidity and mortality in people living with HIV. These authors analyzed HIV-associated mortality and population-level life expectancy in a community-based cohort of 93,903 adults in a rural community in KwaZulu-Natal, South Africa, after initiation of a public sector ART program (535,428 person-years of observation and 9992 deaths between 2001 and 2014).

For the total community population, the death rate decreased from 23.1 (95% confidence interval, 22.3–23.9) per 1000 person-years between 2001 and 2004 to 13.6 (13.0–14.2) per 1000 person-years between 2011 and 2014. Between 2003 and 2014, life expectancy of adult men and women increased by 15.2 years (95% CI, 12.4–17.8) and 17.2 years (CI, 14.5–20.2), respectively. This translates to a per annum life expectancy increase of 1.38 years for men and 1.58 years for women. The life expectancy gains in men and women were attributed to reductions in pulmonary tuberculosis and HIV-related mortality, accounting for 8.4 adult life-years (79.7%) in men and 12.8 adult life-years (90.7%) in women.

The life expectancy deficit, which is defined as the shortfall of the population-wide adult life expectancy compared with that of the HIV-negative population, decreased to 1.2 years (CI, –2.9 to 5.8) for men and 5.3 years (CI, 2.6–7.8) for women by 2014. More than 80% of the life expectancy deficit was due to pulmonary tuberculosis and HIV.

CITATION(S):

Reniers G et al. Trends in the burden of HIV mortality after roll-out of antiretroviral therapy in KwaZulu-Natal, South Africa: An observational community cohort study. Lancet HIV 2016 Dec 9; [e-pub]. 

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