Life expectancy trends in adults on antiretroviral treatment in South Africa.

Johnson, Leigh F; Keiser, Olivia; Fox, Matthew P; Tanser, Frank; Cornell, Morna; Hoffmann, Chris J; Prozesky, Hans; Boulle, Andrew; Davies, Mary-Ann (2016). Life expectancy trends in adults on antiretroviral treatment in South Africa. AIDS, 30(16), pp. 2545-50. Lippincott Williams & Wilkins 10.1097/QAD.0000000000001197

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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. METHOD 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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine

UniBE Contributor:

Keiser, Olivia

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

0269-9370

Publisher:

Lippincott Williams & Wilkins

Language:

English

Submitter:

Doris Kopp Heim

Date Deposited:

18 Aug 2016 15:25

Last Modified:

22 Jun 2017 14:20

Publisher DOI:

10.1097/QAD.0000000000001197

PubMed ID:

27428744

BORIS DOI:

10.7892/boris.86122

URI:

https://boris.unibe.ch/id/eprint/86122

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