The empirical evidence for the impact of HIV on adult mortality in the developing world: data from serological studies.

BACKGROUND: Although national data in many African countries indicate rapidly rising mortality levels in the 1990s, only studies with information on the HIV serostatus of study subjects can provide the direct evidence that these changes are caused by HIV and quantify its contribution. SURVIVAL: Median estimated survival from HIV seroconversion appears to be 8-9 years for individuals infected at 20-29 years, and is considerably shorter for older ages. Differences between estimates include: age structure, survivorship bias and mortality rates in uninfected persons. MORTALITY RATES: Mortality rates for uninfected individuals in developing countries are 2-5 deaths per 1000 PY for those in their teens and twenties, increasing to 5-17 per 1000 PY for those in their thirties and forties; already 10 and 20-fold the rates in industrialized countries. Rates for infected individuals are higher still and vary considerably: 25-45, 70-120, 90-150, and 90-200 deaths per 1000 PY for those in their teens, twenties, thirties and forties respectively. Standardized for age, those infected experience 9-20 and 15-25 times the mortality rates of uninfected men and women respectively. CONCLUSION: The impact of HIV on adult mortality in developing countries has been greatest in individuals in their twenties and thirties and is proportionately larger in women than men. Combining the available data yields a clearer picture, which could inform policy on delivery of potent anti-HIV therapy in resource-poor countries, and act as the baseline against which the impact of therapy at the population level can be assessed.