sub-Saharan Africa, but it is unclear how mortality compares to the non-HIVââ?¬â??infected population. We compared mortality\r\nrates observed in HIV-1ââ?¬â??infected patients starting ART with non-HIVââ?¬â??related background mortality in four countries in sub-\r\nSaharan Africa.\r\nMethods and Findings: Patients enrolled in antiretroviral treatment programmes in CoÃ?â? te dââ?¬â?¢Ivoire, Malawi, South Africa, and\r\nZimbabwe were included. We calculated excess mortality rates and standardised mortality ratios (SMRs) with 95%\r\nconfidence intervals (CIs). Expected numbers of deaths were obtained using estimates of age-, sex-, and country-specific,\r\nHIV-unrelated, mortality rates from the Global Burden of Disease project. Among 13,249 eligible patients 1,177 deaths were\r\nrecorded during 14,695 person-years of follow-up. The median age was 34 y, 8,831 (67%) patients were female, and 10,811\r\nof 12,720 patients (85%) with information on clinical stage had advanced disease when starting ART. The excess mortality\r\nrate was 17.5 (95% CI 14.5ââ?¬â??21.1) per 100 person-years SMR in patients who started ART with a CD4 cell count of less than 25\r\ncells/ml and World Health Organization (WHO) stage III/IV, compared to 1.00 (0.55ââ?¬â??1.81) per 100 person-years in patients\r\nwho started with 200 cells/ml or above with WHO stage I/II. The corresponding SMRs were 47.1 (39.1ââ?¬â??56.6) and 3.44 (1.91ââ?¬â??\r\n6.17). Among patients who started ART with 200 cells/ml or above in WHO stage I/II and survived the first year of ART, the\r\nexcess mortality rate was 0.27 (0.08ââ?¬â??0.94) per 100 person-years and the SMR was 1.14 (0.47ââ?¬â??2.77).\r\nConclusions: Mortality of HIV-infected patients treated with combination ART in sub-Saharan Africa continues to be higher\r\nthan in the general population, but for some patients excess mortality is moderate and reaches that of the general\r\npopulation in the second year of ART. Much of the excess mortality might be prevented by timely initiation of ART.
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