The effect of HIV on adult mortality: evidence from a large cohort of South African gold-miners with known dates of seroconversion and 10 years of follow-up

Judith R. Glynn, London School of Hygiene and Tropical Medicine
Pam Sonnenberg, London School of Hygiene and Tropical Medicine
Gill Nelson, National Institute for Occupational Health
Andre Bester, Gold Fields Ltd
Stuart Shearer, Gold Fields Ltd
Jill Murray, University of the Witwatersrand

A major determinant of adult mortality in sub-Saharan Africa is HIV infection, yet knowledge of the way mortality changes by duration of HIV infection in Africa is based on only a few hundred individuals. We present a retrospective cohort study of 1949 South African gold-miners, with known dates of seroconversion to HIV, and follow-up of >10 years, compared to 6222 HIV-negative men. While employed, 259 HIV-positive and 249 HIV-negative miners died, giving all-cause mortality rates of 30/1000 in the HIV-positive and 6/1000 in the HIV-negative. Mortality rates were stable in the HIV-negatives over time, but increased quickly with time since seroconversion in the HIV-positives: 6/1000 at <1 year, 18/1000 at 1-2 years, 54/1000 at 4-5 years - similar rates to those in the West before antiretrovirals . Full results, including home follow-up, will be presented. The proportion of deaths in South Africa attributable to HIV over time will be estimated.