Mortality trends in the era of antiretroviral therapy

Reniers, Georges; Slaymaker, Emma; Nakiyingi‐Miiro, Jessica; Nyamukapa, Constance; Crampin, Amelia C.; Herbst, Kobus; Urassa, Mark; Otieno, Fredrick; Gregson, Simon; Sewe, Maquins; Michael, Denna; Lutalo, Tom; Hosegood, Victoria; Kasamba, Ivan; Price, Alison; Nabukalu, Dorean; McLean, Estelle; Żaba, Basia

doi:10.1097/qad.0000000000000496

Cited by 100 publications

(54 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This is consistent with various lines of evidence noting a fall in adult mortality from around 2005, which is commonly attributed to the impact of antiretroviral treatment on HIV-related mortality [15, 28]. In the platinum cohort described earlier [19], mortality rose sharply between 1993 and 2002, declining thereafter, but with a second peak in 2009 that was not seen in the current study.…”

Section: Discussionsupporting

confidence: 93%

Precarious transition: a mortality study of South African ex-miners

et al. 2018

View full text Add to dashboard Cite

BackgroundDespite their burden of a triple epidemic of silicosis, tuberculosis and HIV infection, little is known about the mortality experience of miners from the South African mining industry once they leave employment. Such information is important because of the size and dispersion of this population across a number of countries and the progressive nature of these diseases.MethodsThis study included 306,297 South African miners who left the industry during 2001–2013. The study aimed to calculate crude and standardised mortality rates, identify secular trends in mortality and model demographic and occupational risk factors for mortality.ResultsCrude mortality rates peaked in the first year after exit (32.8/1000 person-years), decreasing with each year from exit. Overall mortality was 20% higher than in the general population. Adjusted annual mortality halved over the 12 year period. Mortality predictors were being a black miner [adjusted hazard ratio (aHR) 3.30; 95% confidence interval (CI) 3.15–3.46]; underground work (aHR 1.33; 95% CI 1.28–1.39); and gold aHR 1.15 (95% CI 1.12–1.19) or multiple commodity employment (aHR 1.15; 95% CI 1.11–1.19).ConclusionsThis is the first long-term mortality assessment in the large ex-miner population from the South African mining industry. Mortality patterns follow that of the national HIV-tuberculosis epidemic and antiretroviral treatment availability. However, ex-miners have further elevated mortality and a very high mortality risk in the year after leaving the workforce. Coordinated action between the mining industry, governments and non-governmental organisations is needed to reduce the impact of this precarious transition.Electronic supplementary materialThe online version of this article (10.1186/s12889-018-5749-2) contains supplementary material, which is available to authorized users.

show abstract

Section: Discussionsupporting

confidence: 93%

Precarious transition: a mortality study of South African ex-miners

et al. 2018

View full text Add to dashboard Cite

show abstract

“…Mortality reductions among PLHIV have generally been larger for women than for men,38 and that is thought to be associated with women's greater engagement with HIV services. However, the remaining burden of HIV-related mortality –as measured by the adult life-years lost to HIV–remains higher for women than for men.…”

Section: Data Resource Usementioning

confidence: 99%

Data Resource Profile: Network for Analysing Longitudinal Population-based HIV/AIDS data on Africa (ALPHA Network)

et al. 2016

Self Cite

View full text Add to dashboard Cite

Summary The Network for Analysing Longitudinal Population-based HIV/AIDS data on Africa (ALPHA Network, http://alpha.lshtm.ac.uk/) brings together ten population-based HIV surveillance sites in eastern and southern Africa, and is coordinated by the London School of Hygiene and Tropical Medicine (LSHTM). It was established in 2005 and aims to (i) broaden the evidence base on HIV epidemiology for informing policy, (ii) strengthen the analytical capacity for HIV research, and (iii) foster collaboration between network members. All study sites, some starting in the late 1980s and early 1990s, conduct demographic surveillance in populations that range from approximately 20 to 220 thousand individuals. In addition, they conduct population-based surveys with HIV testing, and verbal autopsy interviews with relatives of deceased residents. ALPHA Network datasets have been used for studying HIV incidence, sexual behaviour and the effects of HIV on mortality, fertility, and household composition. One of the network's substantive focus areas is the monitoring of AIDS mortality and HIV services coverage in the era of antiretroviral therapy. Service use data are retrospectively recorded in interviews and supplemented by information from record linkage with medical facilities in the surveillance areas. Data access is at the discretion of each of the participating sites, but can be coordinated by the network.

show abstract

“…Death rate is markedly less than earlier reported from Zimbabwe; a 15% death rate was reported in an earlier study of Zimbabwean patients attending the DART study,30 while a 7.5% death rate was reported from a 5-year cohort study of mother–baby pairs in peri-urban Harare pre-ART 31. This reduction in the number of deaths points to the improvement of care and treatment of HIV-infected patients compared to early days of HIV and ART 32–34. Only 83 patients had both nadir and baseline CD4 counts, 12.1% of the patients had nadir CD4 counts >350 cells/mm 3 , 61.5% of the patients had baseline CD4 counts >350 cells/mm 3 , and 69.5% of the patients had desirable CD4 counts >350 cells/mm 3 at follow-up.…”

Section: Discussionmentioning

confidence: 60%

<div>Changes in coronary heart disease risk profiles of HIV patients in Zimbabwe over 9 months: a follow-up study</div>

Zhou¹,

Oektedalen²,

Shawarira–Bote³

et al. 2016

HIV

View full text Add to dashboard Cite

Dyslipidemia, hypertension, inflammation, and coronary heart disease (CHD) are adverse events in human immunodeficiency virus (HIV)-infected patients even if they are receiving antiretroviral therapy (ART). Yet, data on CHD risk induced by HIV or ART in sub-Saharan Africa are limited. The aim of this longitudinal study was to describe changes in CHD risk profiles measured by lipids, inflammatory markers, and Framingham scores among HIV-positive patients previously reported from Harare, Zimbabwe. Patients were grouped into ART-experienced patients (n=147) and ART-naïve patients (n=23) and followed up for 9 months. Generalized least squares random-effects modeling was applied to explain changes in total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein, TC/HDL ratio, myeloperoxidase, highly sensitive C-reactive protein, and Framingham scores over the 9-month period. Independent variables included age, sex, monthly earning, body mass index, systolic blood pressure (SBP), diastolic blood pressure, duration of HIV diagnosis, duration of ART, viral load, and CD4 count. In ART-experienced patients, there was a substantial decrease in TC over time, ART-negative patients showed a significant increase in TC and HDL over time, and the increase in TC was associated with high viral load and low duration of HIV diagnosis, while increase in HDL was associated with young age, low body mass index, and low SBP. Framingham risk scores increased with time in ART-positive patients, and the change was positively correlated with age, sex, high SBP, and low HDL. There was no association between calculated CHD risk (TC/HDL ratio or Framingham score) and changes in levels of inflammatory markers (myeloperoxidase and highly sensitive C-reactive protein) in any of the patient groups. In conclusion, ART-experienced HIV-positive patients show changes in lipid values over time that makes it necessary to include lipid monitoring in order to reduce any risk of long-term CHD.

show abstract

Mortality trends in the era of antiretroviral therapy

Abstract: Supplemental Digital Content is available in the text

Cited by 100 publications

References 30 publications

Precarious transition: a mortality study of South African ex-miners

Precarious transition: a mortality study of South African ex-miners

Data Resource Profile: Network for Analysing Longitudinal Population-based HIV/AIDS data on Africa (ALPHA Network)

<div>Changes in coronary heart disease risk profiles of HIV patients in Zimbabwe over 9 months: a follow-up study</div>

Contact Info

Product

Resources

About