Dramatic increases in life expectancy in a high-burden HIV setting due to ARV rollout

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The first evidence of dramatic changes in adult life expectancy in an HIV-endemic region, from individually measured data in a complete population cohort, showed large increases in adult life expectancy since the roll-out of antiretroviral (ARV) treatment. The survival benefits in economic terms were also found to far exceed the cost of ARV treatment, according to a study of the effects of ARV in rural KwaZulu-Natal, South Africa, presented by Jacob Bor at the 19th International AIDS Conference (AIDS 2012) in Washington DC.

A complete population cohort of 149,640 individuals in a community in rural KwaZulu-Natal, with an adult HIV prevalence of 28%, was followed longitudinally between 2000 and 2011. Continuous time data on dates of birth and death were collected through semi-household surveys where the response rate was greater than 99%.

Between 2000 and 2003, the life expectancy of this population fell from 59 years to 52 years due to high rates of HIV infection and lack of access to ARV treatment. However, since 2003 – when ARVs became available through the public health system – there has been a gain of 8.2 years in life expectancy from 52.4 years in 2003 to 60.6 years in 2011. The adult life-expectancy years gained were found to be 9.5 years for women, compared to 6.6 years for men. Regardless of exposure to HIV, there has been a 13.9 year increase in median life expectancy of a typical person.


response rate

The proportion of people asked to complete a survey who do so; or the proportion of people whose health improves following treatment.

Researchers calculated that the cumulative estimated monetary value of life-expectancy gains to a 15 year old was US$79,000. This compared to the present discounted value of an individual’s lifetime contribution to the community’s expected treatment costs for ARVs, which was found to be US$2400. This model assumes that HIV treatment would cost US$500 per patient, per year.

“When we compare the economic gains of keeping people alive through ARVs and how this assists them in contributing to the economy with the relatively small cost of ARV treatment, it only makes economic sense to keep providing ARV treatment to as many people are need it. Beyond the moral arguments for keeping people alive, groups who think in monetary terms only can see from our data that keeping people on treatment is economically beneficial,” said Mr Bor.

Although changes in population life expectancy have been modelled, they have not yet been measured using actual data. For the first time, this study measured changes in population-level adult life expectancy associated with the rollout of ARV treatment, in a setting of very high HIV prevalence. Researchers hoped that by using population-level outcomes that capture the spillover effects of the availability of ARVs, this would allow individuals, donors and governments to see the value of ARV programmes when making decisions regarding ARV investments.


Bor J et al. Dramatic increases in adult life expectancy and economic benefits after ART roll out in rural South Africa. 19th International Conference on AIDS, abstract TULBE05, Washington, DC, July 2012.

View the abstract on the conference website.