Data available on HIV deaths
Model estimates 250 000 at height in 2009
UNIQUE data has made it easier for scientists to estimate the number of HIV-infected South Africans who died of the virus before antiretrovirals were available.
The data by scientists at Wits University, and at the South African Centre for Epidemiological Modelling and Analysis (Sacema) at Stellenbosch University, published the paper – HIV-attributable causes of death in the medical ward at Chris Hani Baragwanath Hospital – in a medical journal.
Pulmonologist in the Department of Internal Medicine in the School of Clinical Medicine at Wits and at Helen Joseph Hospital, Dr Andrew Black, was the lead author, and estimated that the number of deaths attributable to HIV in South Africa in 2009, during the height of the epidemic, varied from 225000 to 350000 per year.
The numbers were based on a range of data sources and showed an estimated number of deaths from HIV by 2009 at 250000 per year.
“Due to the stigma associated with HIV at that time, clinicians often did not include HIV status or Aids-defining causes of death on the official death notification forms. The Baragwanath mortality record (BMR), however, allowed for a more accurate and detailed record of the causes of death,” the paper said.
Between 2006 and 2009, the BMR shows that 15 725 adults died and each patient’s hospital number, age, sex, cause of death, date of admission, date of death, HIV status, CD4+ cell count and antiretroviral therapy status was recorded.
“We gathered data from just under 16 000 patients between 2002 and 2006. This made it the largest study of its kind in Africa,” said Black, who along with Professor Brian Williams, a mathematical modeller at Sacema, led the data analysis team.
The researchers said the high prevalence of HIV among those who died demonstrated the impact of the HIV epidemic on adult mortality, on hospital services, and the extent to which early antiretroviral treatment would have reduced the burden of both.
“The data revealed risks for a range of conditions that were over ten-fold. This is important because it tells us that any patient admitted now for a range of diseases – especially rare fungal ones, such as Cryptococcus, and even some respiratory diseases – ought to be rapidly assessed for their HIV status and, if positive, be offered antiretrovirals immediately,” said Black.
“One of the challenges was to merge techniques normally reserved for chronic disease and cancer epidemiology with looking at an infectious cause. This model enabled us to estimate the Aids-attributable fraction for those dying from Cryptococcus’s, Kaposi’s sarcoma and Pneumocystis jirovecii, tuberculosis, gastroenteritis, and anaemia,” said Williams.