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Background: Adult mortality declined considerably since the expansion of antiretroviral therapy (ART) programs, but the residual burden of HIV on adult mortality in generalized epidemics remains poorly understood.
Methods: We use demographic and HIV surveillance data from 2001 to 2014 covering a rural South African population of around 45,000 individuals aged 15 to 100. We use non-parametric survival analysis for estimating (i) population-wide adult LE gains since the introduction of ART in 2004, and (ii) the shortfall of the adult LE compared to that of the HIV negative population (i.e., the LE deficit). LE gains and deficits for groups of calendar years are decomposed by age and cause of death with data generated by a new verbal autopsy interpretation tool (InSilicoVA). All estimates are disaggregated by sex.
Results: Since the roll-out of ART, population-level adult LE has increased by 15.2 years for men (95%-CI: 12.4-17.8), and 17.2 years for women (95%-CI: 14.5-20.2). Reductions in TB and HIV related mortality account for 80% of the LE gains among men, and over 90% among women. For men, 10% is the result of a decline in external injuries. As a result of the mortality reductions, the LE deficit in 2014 had contracted to 1.2 years for men (95%-CI: -2.0-5.0) and to 5.3 years for women (95%-CI: 2.8-7.8). TB and HIV are responsible for over 90% of the LE deficit among men in 2011-ยด14, and for over 84% among women. The remainder is largely attributed to other communicable diseases (Figure 1).
Conclusions: The burden of HIV on adult mortality in this population is rapidly shrinking, but remains sizable for women, despite their better engagement with HIV care services. The gains in adult life-years to date as well as the current LE deficit are almost exclusively due to differences in HIV and TB related mortality.

Figure 1: Age-cause group contributions to the LE difference between the HIV neg. population and the population as a whole, by sex (2011-''14)
[Figure 1: Age-cause group contributions to the LE difference between the HIV neg. population and the population as a whole, by sex (2011-''14)]