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Home >> Publications >> Life expectancy trends in adults on antiretroviral treatment in South Africa

Publication

Author(s):

Johnson LF, Keiser O, Fox MP, Tanser F, Cornell M, Hoffmann CJ, Prozesky H, Boulle A, Davies MA

Pub Title:

Life expectancy trends in adults on antiretroviral treatment in South Africa

Pub Date:

Oct 23 2016

Pub Region(s):

Southern Africa

Journal:

Title: 
AIDS
Link: 
http://tinyurl.com/z4o6k6d

PubMed: 27428744
Pub PDF:

Abstract

Background: Previous studies have reported improvements in life expectancies of patients on antiretroviral treatment (ART) over time, but it is not clear whether these improvements are explained by changes in baseline clinical characteristics, longer duration on ART, or changes in clinical practices.

Methods: Two parametric survival models were fitted to mortality data from South African ART cohorts that had linked patient records to the national vital registration system. The first model estimated mortality by age, sex, cohort, baseline CD4 count, time since ART initiation and period of ART initiation; the second model included only age, sex, cohort and period of follow-up. Life expectancies were calculated from the estimated mortality rates.

Results:The first model estimated little change in mortality over time: women starting ART at age 35, at CD4 counts of 200 cells/μl or higher, had life expectancies of 32.7 (95% CI: 31.6-33.6), 32.4 (95% CI: 31.3-33.4) and 33.0 (95% CI: 32.0-34.1) in the 2001-2006, 2007-2009 and 2010-2014 periods respectively. However, the second model estimated a significant improvement in life expectancy; for all women on ART at age 35, corresponding life expectancies were 13.0 (95% CI: 12.1-14.2), 20.4 (95% CI: 19.5-21.4) and 26.1 (95% CI: 25.2-26.9) respectively.

Conclusions:Although life expectancies in South African ART patients have improved over time, these improvements are not observed after controlling for changes in baseline CD4 count and ART duration. This suggests that changes in clinical practice and programme scale have had little impact on ART mortality in South Africa.

 

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Citation:

AIDS. 2016 Jul 13. [Epub ahead of print] Life expectancy trends in adults on antiretroviral treatment in South Africa. Johnson LF1, Keiser O, Fox MP, Tanser F, Cornell M, Hoffmann CJ, Prozesky H, Boulle A, Davies MA; International Epidemiologic Databases to Evaluate AIDS Southern Africa (IeDEA-SA) collaboration.