The Impact of HIV, an Antiretroviral Programme and Tuberculosis on Mortality in South African Platinum Miners, 1992–2010

Article English OPEN
Lim, Megan S. C. ; Dowdeswell, Robert J. ; Murray, Jill ; Field, Nigel ; Glynn, Judith R. ; Sonnenberg, Pam (2012)
  • Publisher: Public Library of Science
  • Journal: PLoS ONE, volume 7, issue 6 (eissn: 1932-6203)
  • Related identifiers: pmc: PMC3382208, doi: 10.1371/journal.pone.0038598
  • Subject: Global Health | HIV epidemiology | Research Article | Tropical Diseases (Non-Neglected) | Infectious diseases | Tuberculosis | Infectious Disease Epidemiology | Medicine | Viral diseases | Bacterial Diseases | Epidemiology | HIV | HIV clinical manifestations

Background HIV and tuberculosis (TB) are the most common causes of death in South Africa. Antiretroviral therapy (ART) programmes should have had an impact on mortality rates. This study describes the impact of HIV, a Wellness (HIV/ART) programme and TB on population-wide trends in mortality and causes of death among South African platinum miners, from before the HIV epidemic into the ART era. Methodology/Principal Findings Retrospective analysis was conducted using routinely-collected data from an open cohort. Mortality and causes of death were determined from multiple sources, including cardiorespiratory autopsy records. All-cause and cause-specific mortality rates were calculated by calendar year. 41,665 male miners were observed for 311,938 person years (py) with 3863 deaths. The all-cause age-standardised mortality rate increased from 5.9/1000py in 1992 to 20.2/1000py in 2002. Following ART rollout in 2003, annual mortality rates fluctuated between 12.4/1000py and 19.3/1000py in the subsequent 7 years. Half of all deaths were HIV-related and 21% were caused by TB. Half (50%) of miners who died of HIV after ART rollout had never been registered on the Wellness programme. TB was the most common cause of death in HIV positive miners, increasing from 28% of deaths in the pre-ART period to 41% in the post-ART period. Conclusions/Significance This population-based cohort experienced a rapid increase in mortality from 1996 to 2003 due to increases in HIV and TB mortality. Following ART rollout there was a decrease in mortality, but a steady decrease has not been sustained. Possible explanations for these trends include the changing composition of the workforce, maturation of the HIV epidemic, insufficient uptake of ART and an increase in the proportion of deaths due to TB. In order to make a significant and sustained reduction in mortality in this population, expanding and integrating HIV and TB care and treatment is essential.
  • References (29)
    29 references, page 1 of 3

    1. Rajaratnam JK, Marcus JR, Levin-Rector A, Chalupka AN, Wang H, et al. (2010) Worldwide mortality in men and women aged 15-59 years from 1970 to 2010: a systematic analysis. Lancet 375: 1704-1720.

    2. Laubscher R, Bradshaw D, Bourne D, Dorrington R (2009) Rapid surveillance of AIDS mortality in South Africa. IUSSP International Population Conference. Marrakech.

    3. Reniers G, Araya T, Davey G, Nagelkerke N, Berhane Y, et al. (2009) Steep declines in population-level AIDS mortality following the introduction of antiretroviral therapy in Addis Ababa, Ethiopia. Aids 23: 511-518.

    4. Mwagomba B, Zachariah R, Massaquoi M, Misindi D, Manzi M, et al. (2010) Mortality reduction associated with HIV/AIDS care and antiretroviral treatment in rural Malawi: evidence from registers, coffin sales and funerals. PLoS One 5: e10452.

    5. Nyirenda M, Hosegood V, Barnighausen T, Newell ML (2007) Mortality levels and trends by HIV serostatus in rural South Africa. Aids 21 Suppl 6: S73-79.

    6. Herbst AJ, Cooke GS, Barnighausen T, KanyKany A, Tanser F, et al. (2009) Adult mortality and antiretroviral treatment roll-out in rural KwaZulu-Natal, South Africa. Bull World Health Organ 87: 754-762.

    7. Jahn A, Floyd S, Crampin AC, Mwaungulu F, Mvula H, et al. (2008) Population-level effect of HIV on adult mortality and early evidence of reversal after introduction of antiretroviral therapy in Malawi. Lancet 371: 1603-1611.

    8. Harries AD, Zachariah R, Corbett EL, Lawn SD, Santos-Filho ET, et al. (2010) The HIV-associated tuberculosis epidemic-when will we act? Lancet 375: 1906- 1919.

    9. Lawn SD, Kranzer K, Wood R (2009) Antiretroviral therapy for control of the HIV-associated tuberculosis epidemic in resource-limited settings. Clin Chest Med 30: 685-699, viii.

    10. Abdool Karim SS, Naidoo K, Grobler A, Padayatchi N, Baxter C, et al. (2010) Timing of initiation of antiretroviral drugs during tuberculosis therapy. N Engl J Med 362: 697-706.

  • Related Research Results (2)
  • Metrics
    No metrics available
Share - Bookmark