Abstract
Background: The lack of representative data on causes of death in sub-Saharan Africa (SSA) hampers our understanding of the regional burden of HIV and impact of interventions. In spite of the roll-out of antiretroviral therapy (ART) programs, HIV-infected individuals are still dying from complications of AIDS in SSA. We reviewed autopsy findings in SSA to observe whether the prevalence of 14 AIDS-defining illnesses changed from the pre-ART era to the post-ART era. Methods: We conducted a systematic review of autopsy findings in SSA using Medline, CINAHL, Evidence Based Medicine, EMBASE, Scopus, Web of Science, and abstracts from the Conference on Retroviruses and Opportunistic Infections, for literature published between January 1, 1990 and September 30, 2018. We focused on 14 AIDS-defining illnesses as causes of death. Results: In total, 33 studies were identified, including 9 from South Africa, 4 from the Ivory Coast, and the rest from eastern regions of sub-Saharan Africa. Of these, 18 studies were included in the meta-analyses for each of the AIDS-defining illnesses for adults. A ‘mixed group’ of studies that included adults and children was used for separate meta-analyses. Most opportunistic infections (OIs) showed a decrease in prevalence, with the notable exception of tuberculosis (TB), which showed a 13% increase in adult deaths and a 5% increase in mixed population group deaths. Kaposi’s sarcoma and non-Hodgkin’s lymphoma both showed a notable increase in prevalence, and liver disease showed a 10% increase in prevalence in the adult group. Conclusions: Even though ART has reduced the contribution of OIs to causes of death for people infected with HIV in SSA, targeted and strategic efforts are needed in order to strengthen existing prevention, diagnosis, and treatment of TB. More research is required to understand the complex role ARTs have on liver and kidney diseases.
Highlights
The last decade has seen tremendous changes in the landscape of HIV treatment, care, and mortality
We review autopsy findings in sub-Saharan Africa (SSA) to observe whether the prevalence of 14 AIDS-defining illnesses changed from the pre-antiretroviral therapy (ART) era to the post-ART era
Other articles and abstracts were excluded because insufficient autopsies in HIV-positive individuals were performed, the autopsies were not reported by HIV status, or reporting on outcomes was duplicated for the same study population
Summary
The last decade has seen tremendous changes in the landscape of HIV treatment, care, and mortality. High-income countries have shown that causes of death (COD) in HIV-infected individuals have changed, with non-AIDS-defining cancers, cardiovascular diseases (CVD), and liver diseases becoming the leading causes of mortality. AIDS-defining illnesses such as OIs or malignancies have remained a major cause of morbidity and mortality in HIV-infected individuals in low-resource settings, even in the era of wide-scale ART rollout[6]. We reviewed autopsy findings in SSA to observe whether the prevalence of 14 AIDS-defining illnesses changed from the pre-ART era to the post-ART era. 18 studies were included in the meta-analyses for each of the AIDS-defining illnesses for adults. Most opportunistic infections (OIs) showed a decrease in prevalence, with the notable exception of tuberculosis (TB), which showed a 13% increase in adult deaths and a 5% increase in mixed population group deaths. Kaposi’s sarcoma and non-Hodgkin’s lymphoma both showed a notable increase in prevalence, and liver disease showed a 10% increase in prevalence in the
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