Cape Times

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.

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