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AIDS. 2007 Nov;21 Suppl 6:S21-9.

HIV-1 disease progression and mortality before the introduction of highly active antiretroviral therapy in rural Uganda.

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1
MRC-UVRI Uganda Research Unit on AIDS, Entebbe, Uganda. lieve.vanderpaal@mrcuganda.org

Abstract

OBJECTIVE:

To provide estimates of survival and progression to different HIV disease endpoints after HIV infection among adults in a rural Ugandan setting.

DESIGN:

A prospective population-based cohort study.

METHODS:

Eligible individuals at least 15 years of age with documented HIV seroconversion were recruited from a general population cohort in rural Uganda, along with a randomly selected proportion of HIV-prevalent and HIV-negative individuals. All participants were followed up every 3 months, and CD4 cell counts taken every 6 months in HIV-positive participants. Life tables and Kaplan-Meier functions were used to estimate survival patterns for all endpoints [death, time to World Health Organization (WHO) stage 2, 3, AIDS and CD4 cell count < 200 cells/mul]. Analysis of follow-up time was truncated when antiretroviral therapy (ART) became available in the area in January 2004.

RESULTS:

We recruited 240 HIV incident cases, 108 prevalent cases and 257 HIV-negative controls. Crude mortality rates were 70.0 per 1000 person-years in HIV-positive, and 12.1 per 1000 person-years in HIV-negative individuals. The median time from seroconversion to death was 9.0 years (N = 240) and 6.2 years to a CD4 cell count less than 200 cells/mul or WHO stage 4 (N = 229). The median time from ART eligibility (CD4 cell count < 200 cells/mul, < 350 cells/mul and WHO stage 3, or WHO stage 4) to death was 34.7 months. Older age at seroconversion was a risk factor for faster progression to death and ART eligibility.

CONCLUSION:

HIV progression in this African cohort is similar to that reported in industrialized countries before the widespread introduction of ART.

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