The Effect of Antiretroviral Therapy for HIV Infection on Adult Life Expectancy in Southern and Eastern Africa

Georges Reniers, London School of Hygiene and Tropical Medicine (LSHTM)
Jeff Eaton, Imperial College London

Few studies directly measure the population-wide impact of antiretroviral therapy (ART) on HIV related mortality in Africa, with existing estimates relying on model extrapolations of clinical data. We describe trends in adult life expectancy (LE), the LE gains attributable to ART, and the remaining LE deficit due to HIV in seven population-based serosurveillance sites. Non-parametric survival analysis is used to estimate adult LE and LE deficit due to HIV. We fit a model of age-specific HIV incidence and natural survival to estimate counterfactual LE trends without ART and thus gains attributable to ART. Estimates are disaggregated by sex and span the years 2000 to 2012. LE gains range between 8 and 20 years and are larger for women than men. LE gains are largest in eastern Africa, where HIV prevalence declined prior to ART availability, but the effect of ART is largest in South African sites, where LE would have continued to decline without ART.