Is HIV-1 likely to become a leading cause of adult mortality in sub-Saharan Africa?

Concerns are sometimes expressed at the extent to which HIV-1 is prioritized within international and national health budgets and as a research issue, on the grounds that much larger numbers of people in developing countries currently die from other diseases, such as malaria and tuberculosis. We use a previously described mathematical model to explore how the HIV-1 epidemic could develop within a sub-Saharan African context and investigate the trends and patterns of adult mortality which could follow. Two contrasting scenarios are studied, one which turns population growth rates negative and another which does not. In both cases, HIV-1-related disease accounts for over 75% of annual deaths among men and women aged 15-60 years by year 25 of the epidemic. Relatively little change in mortality is seen in the early years of the simulated epidemics. However, by year 15, expectation of life at age 15 has fallen from 50 to below 30 years. The fragmentary evidence now available from empirical studies supports the impression that HIV-1 is rapidly emerging as a leading cause of adult deaths in areas of sub-Saharan Africa. Observed patterns of age-dependent mortality reflect those projected in the model simulations.