• Menard Chihana, Sian Floyd, Anna Molesworth, Amelia C Crampin, Ndoliwe Kayuni, Alison Price, Basia Zaba, Andreas Jahn, Hazzie Mvula, Albert Dube, Bagrey Ngwira, Judith R Glynn, and Neil French.
• Karonga Prevention Study, Chilumba, Malawi. menard.chihana@kpsmw.org
• Trop. Med. Int. Health. 2012 Aug 1; 17 (8): e74-83.

ObjectivesDeveloping countries are undergoing demographic transition with a shift from high mortality caused by communicable diseases (CD) to lower mortality rates caused by non-communicable diseases (NCD). HIV/AIDS has disrupted this trend in sub-Saharan Africa. However, in recent years, HIV-associated mortality has been reduced with the introduction of widely available antiretroviral therapy (ART). Side effects of ART may lead to increased risk of cardiovascular diseases, raising the prospects of an accelerated transition towards NCD as the primary cause of death. We report population-based data to investigate changes in cause of death owing to NCD during the first 4 years after introduction of HIV treatment.MethodsWe analysed data from a demographic surveillance system in Karonga district, Malawi, from September 2004 to August 2009. ART was introduced in mid-2005. Clinician review of verbal autopsies conducted 2-6 weeks after a death was used to establish a single principal cause of death.ResultsOver the entire period, there were 905 deaths, AIDS death rate fell from 505 to 160/100,000 person-years, and there was no evidence of an increase in NCD rates. The proportion of total deaths attributable to AIDS fell from 42% to 17% and from NCD increased from 37% to 49%.DiscussionOur findings show that 4 years after the introduction of ART into HIV care in Karonga district, all-cause mortality has fallen dramatically, with no evidence of an increase in deaths owing to NCD.© 2012 Blackwell Publishing Ltd.

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