Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa.
S Afr Med J. 2019 Dec 5;109(11b):41-44. doi: 10.7196/SAMJ.2019.v109i11b.14283.
South Africa (SA) has one of the largest HIV/AIDS epidemics in the world and the most extensive antiretroviral therapy (ART) programme globally, which was rolled out from 2004. This paper reports the trends in HIV/AIDS mortality pre and post ART rollout in SA. Methods. Vital registration cause-of-death data from Statistics South Africa were adjusted for under-reporting of deaths using demographic methods. Misattributed HIV/AIDS deaths were identified by regressing excess mortality on a lagged indicator HIV antenatal clinic prevalence for causes found to be associated with HIV/AIDS. Background trends in the source-cause mortality rates were estimated from the trend in cause-specific mortality experienced among 75 - 84-year-olds. Mortality rates were calculated using mid-year population estimates and the World Health Organization world standard age-weights. Results. We estimated over 3 189 000 HIV/AIDS deaths for 1997 - 2012. In 1997, 60 336 (14.5%) of deaths were attributed to HIV/AIDS; this number peaked in 2006 at 283 564 (41.9%) and decreased to 153 661 (29.1%) by 2012; female mortality rates peaked in 2005 and those of males in 2006. Men aged 35 years and older had higher mortality rates than did women. While the rates at ages below 65 years in 2012 were lower than those in 2006, rates of those age 65 years and older remained unchanged. Conclusion. The number of HIV/AIDS deaths has almost halved since the ART rollout. Of concern is the high mortality in men 45 years and older and the high mortality of men compared with women in the older ages by 2012; this gap has increased with age. Treatment and prevention programmes should strategise how to target men.
南非（SA）是世界上艾滋病毒/艾滋病流行最严重的国家之一，也是全球抗逆转录病毒治疗（ART）计划最广泛的国家，该计划于 2004 年推出。本文报告了南非在推出抗逆转录病毒治疗前后艾滋病毒/艾滋病死亡率的趋势。
方法。利用人口统计方法对南非统计局的生命登记死因数据进行了死亡漏报调整。通过回归滞后指标 HIV 产前检查流行率来识别归因错误的艾滋病毒/艾滋病死亡人数，该指标与 HIV/AIDS 相关。从 75-84 岁人群经历的特定原因死亡率趋势中估计了来源原因死亡率的背景趋势。死亡率是根据中年人口估计数和世界卫生组织世界标准年龄权重计算的。
结果。我们估计 1997-2012 年期间有超过 3189 000 例艾滋病毒/艾滋病死亡。1997 年，有 60336 例（14.5%）死亡归因于艾滋病毒/艾滋病；这一数字在 2006 年达到峰值，为 283564 例（41.9%），到 2012 年降至 153661 例（29.1%）；女性死亡率在 2005 年达到峰值，男性死亡率在 2006 年达到峰值。35 岁及以上男性的死亡率高于女性。虽然 2012 年 65 岁以下人群的死亡率低于 2006 年，但 65 岁及以上人群的死亡率保持不变。
结论。自推出抗逆转录病毒治疗以来，艾滋病毒/艾滋病死亡人数已减少近一半。令人担忧的是，45 岁及以上男性的死亡率较高，以及 2012 年老年男性与女性的死亡率较高；这一差距随着年龄的增长而扩大。治疗和预防计划应制定战略，如何针对男性。
