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; Prozesky, Hans; Boulle, Andrew; Davies, Mary Ann

doi:10.1097/qad.0000000000001197

Cited by 16 publications

(17 citation statements)

References 14 publications

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“…Due to far higher background mortality rates in men compared with women, female SMRs were higher than male, even though all-cause mortality rates in men were higher than those in women. SMRs declined towards 1 as ART duration increased, suggesting an increasing "normalization" of mortality in ART patients with duration on treatment [51,52]. Our results highlight the need to assess and compare mortality estimates in ART programmes in the context of background mortality.…”

Section: Discussionmentioning

confidence: 70%

Twelve‐year mortality in adults initiating antiretroviral therapy in South Africa

Cornell

Johnson

Wood

et al. 2017

Journal of the International AIDS Society

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Introduction: South Africa has the largest number of individuals living with HIV and the largest antiretroviral therapy (ART) programme worldwide. In September 2016, ART eligibility was extended to all 7.1 million HIV-positive South Africans. To ensure that further expansion of services does not compromise quality of care, long-term outcomes must be monitored. Few studies have reported long-term mortality in resource-constrained settings, where mortality ascertainment is challenging. Combining site records with data linked to the national vital registration system, sites in the International Epidemiology Databases to Evaluate AIDS Southern Africa collaboration can identify >95% of deaths in patients with civil identification numbers (IDs). This study used linked data to explore long-term mortality and viral suppression among adults starting ART in South Africa. Methods: The study was a cohort analysis of routine data on adults with IDs starting ART 2004–2015 in five large ART cohorts. Mortality was estimated overall and by gender using the Kaplan-Meier estimator and Cox’s proportional hazards regression. Standardized mortality ratios (SMRs) were calculated by dividing observed numbers of deaths by numbers expected if patients had been HIV-negative. Viral suppression in patients with viral loads (VLs) in their last year of follow-up was the secondary outcome. Results: Among 72,812 adults followed for 350,376 person years (pyrs), the crude mortality rate was 3.08 (95% CI 3.02–3.14)/100 pyrs. Patients were predominantly female (67%) and the percentage of men initiating ART did not increase. Cumulative mortality 12 years after ART initiation was 23.9% (33.4% male and 19.4% female). Mortality peaked in patients enrolling in 2007–2009 and was higher in men than women at all durations. Observed mortality rates were higher than HIV-negative mortality, decreasing with duration. By 48 months, observed mortality was close to that in the HIV-negative population, and SMRs were similar for all baseline CD4 strata. Three-quarters of patients had VLs in their last year, and 86% of these were virally suppressed. Conclusions: The South African ART programme has shown a remarkable ability to initiate and manage patients successfully over 12 years, despite rapid expansion. With further scale-up, testing and initiating men on ART must be a national priority.

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Section: Discussionmentioning

confidence: 70%

Twelve‐year mortality in adults initiating antiretroviral therapy in South Africa

Cornell

Johnson

Wood

et al. 2017

Journal of the International AIDS Society

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“…These younger children showed advanced dental development. This finding may be a result of the recent rollout of ARVs in 2005 in public hospitals in South Africa; hence, these younger children may have benefitted more from ARVs during the crucial dental growth periods than older children who had access to ARVs at a later stage in their lives.…”

Section: Discussionmentioning

confidence: 96%

“…Since then, much advancement regarding diagnostic tools and disease management has taken place. The disease is now managed, with reasonable success, with the use of antiretroviral (ARV) drug therapy, and as such, the life expectancy of HIV‐infected individuals has increased significantly . With increased life expectancy, long‐term studies on all aspects of the HIV‐infected individuals have become pertinent.…”

Section: Introductionmentioning

confidence: 99%

“…The disease is now managed, with reasonable success, with the use of antiretroviral (ARV) drug therapy, and as such, the life expectancy of HIV-infected individuals has increased significantly. 2 With increased life expectancy, long-term studies on all aspects of the HIV-infected individuals have become pertinent. Documentation of the growth and development of HIV-infected children is of value as this type of information has bearing on forensic © 2019 Special Care Dentistry Association and Wiley Periodicals, Inc. medicine, pediatric dentistry, and orthodontic treatment planning.…”

Section: Introductionmentioning

confidence: 99%

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Dental development in a sample of South African HIV‐positive children

Titinchi

Behardien

2019

Special Care in Dentistry

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Aims While oral soft tissue manifestations associated with HIV‐infection in children are well documented, few studies have investigated the dental development of this group. The aim of this study was to assess dental development in a sample of HIV‐positive children in comparison with an age‐matched HIV‐negative control group. Methods and results The sample comprised 44 HIV‐positive children and 44 HIV‐negative children matched for age, gender, and ethnicity. An orthopantomograph (OPG) of each patient was assessed in order to calculate the dental age. The mineralization stages of teeth were used to calculate the dental age using tables formulated by Phillips and van Wyk‐Kotze for this grouping. Results showed that dental development for both groups were similar to the dental age‐related tables. HIV‐positive children between 8 and 10 years of age showed significantly advanced dental development (p = 0.04). HIV‐positive females showed significant advancement in dental age as compared to their chronological ages. Thirty‐six (81.8%) HIV‐positive children were on antiretroviral (ARV) drugs. Conclusion HIV‐positive children presented stages of dental development in accordance with their chronological ages and in tandem with that of the HIV‐negative controls.

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“…The parameters k g and M g have been set to 0.0105 and 0.117 respectively in men, and to 0.0079 and 0.049 respectively in women. These values were chosen to yield the best fit to HIV-specific mortality estimates at different ART durations in a recent analysis of data from eight South African ART cohorts [415]. The correspondence between the empirically-derived mortality estimates and the model are presented in Figure 6.3.1.…”

Section: Hiv Disease Progressionmentioning

confidence: 99%

MicroCOSM: a model of social and structural drivers of HIV and interventions to reduce HIV incidence in high-risk populations in South Africa

Johnson

Kubjane

Moolla

2018

Preprint

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Executive summary Background and objectives South Africa has one of the highest HIV incidence rates in the world. Although much research has focused on developing biomedical strategies to reduce HIV incidence, there has been less investment in prevention strategies that address the social drivers of HIV spread. Understanding the social determinants of HIV is closely related to understanding high-risk populations (‘key populations’), since many of the factors that place these key populations at high HIV risk are social and behavioural rather than biological. Mathematical models have an important role to play in evaluating the potential impact of new HIV prevention and treatment strategies. However, most of the mathematical modelling studies that have been published to date have evaluated biomedical HIV prevention strategies, and relatively few models have been developed to understand the role of social determinants or interventions that address these social drivers. In addition, many of the mathematical models that have been developed are relatively simple deterministic models, which are not well suited to simulating the complex causal pathways that link many of the social drivers to HIV incidence. The frequency-dependent assumption implicit in most deterministic models also leads to under-estimation of the contribution of high-risk groups to the incidence of HIV. Agent-based models (ABMs) overcome many of the limitations of deterministic models, although at the expense of greater computational burden. This study presents an ABM of HIV in South Africa, developed to characterize the key social drivers of HIV in South Africa and the groups that are at the highest risk of HIV. The objective of this report is to provide a technical description of the model and to explain how the model has been calibrated to South African data sources; future publications will assess the drivers of HIV transmission in South Africa in more detail. Methods The model is an extension of a previously-published ABM of HIV and other sexually transmitted infections (STIs) in South Africa. This model simulates a representative sample of the South African population, starting from 1985, with an initial sample size of 20 000. The population changes in size as a result of births and deaths. Each individual is assigned a date of birth, sex and race (demographic characteristics). This in turn affects the assignment of socio-economic variables. Each individual is assigned a level of educational attainment, which is dynamically updated as youth progress through school and tertiary education, with rates of progression and drop-out depending on the individual’s demographic characteristics. Each individual is also assigned to an urban or rural location, with rates of movement between urban and rural areas depending on demographic characteristics and educational attainment. The model assigns to each individual a number of healthcare access variables that determine their HIV and pregnancy risk. These include their ‘condom preference’ (a measure of the e...

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Life expectancy trends in adults on antiretroviral treatment in South Africa

Cited by 16 publications

References 14 publications

Twelve‐year mortality in adults initiating antiretroviral therapy in South Africa

Twelve‐year mortality in adults initiating antiretroviral therapy in South Africa

Dental development in a sample of South African HIV‐positive children

MicroCOSM: a model of social and structural drivers of HIV and interventions to reduce HIV incidence in high-risk populations in South Africa

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