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Mortality rates of people starting HIV treatment in four African countries approach those of the general population over time, provided that treatment is started before the immune system has been severely damaged, according to research published this week in the open-access journal PLoS Medicine.

In sub-Saharan Africa more than 2 million people with HIV now receive antiretroviral treatment (ART), and mortality in HIV-infected patients who have access to ART is declining. In the new study, Matthias Egger of the University of Berne and colleagues investigated how mortality among HIV-infected people starting ART compares with non-HIV related mortality in Cote d'Ivoire, Malawi, South Africa, and Zimbabwe. The researchers analysed information about people during their first two years on ART in five treatment programs participating in the International epidemiological Databases to Evaluate AIDS (IeDEA) initiative, and obtained estimates of HIV-unrelated deaths in these countries from the World Health Organization Global Burden of Disease (GBD) project.

Their findings indicate that mortality among HIV-infected people during the first two years of ART is higher than in the general population in these four sub-Saharan countries. However, for patients who start ART when they have a high CD4 lymphocyte count and no signs of advanced HIV disease, the excess mortality is moderate and similar to that associated with diabetes.