title: Four years of natural history of HIV-1 infection in african women: a prospective cohort study in Kigali (Rwanda), 1988-1993.
abstract: Clinical features and mortality due to human immunodeficiency virus type-1 (HIV-1) infection in women are described as part of a prospective 4-year cohort study on perinatal transmission of HIV in Kigali, Rwanda. Two hundred fifteen HIV-seropositive (HIV+) and 216 HIV-seronegative (HIV-) pregnant women were enrolled at delivery between November 1988 and June 1989. Clinical information collected during systematic quarterly examinations was compared. HIV antibody tests were performed at delivery and CD4/CD8 lymphocyte counts at 15 days' postpartum. HIV--women who seroconverted during the follow-up period were excluded from the analysis of the comparison group starting at the date of seroconversion. At enrollment, all HIV+ women were asymptomatic for acquired immune deficiency syndrome (AIDS). Incidence of tuberculosis was 2.9 per 100 women-years (WY) after 4 years of follow-up in HIV+ women versus 0.2 per 100 WY among HIV- women (relative risk, 18.2; 95% confidence interval 2.4-137.0). Among HIV+ women, the incidence of AIDS (World Health Organization clinical AIDS definition) was 3.5 per 100 WY. The mortality rate was 4.4 per 100 WY among HIV+ women versus 0.5 per 100 WY among HIV- women. Clinical AIDS was present in only half of the fatalities. Tuberculosis was a major cause of morbidity and mortality in these HIV+ African women. An early diagnosis and an appropriate treatment or prevention of tuberculosis should improve the quality of life of HIV-infected patients in Africa.
authors.affiliation: INSERM U. 330, University of Bordeaux II, France.
authors.forename: V
authors.initials: V
authors.lastname: Leroy
authors.forename: P
authors.initials: P
authors.lastname: Msellati
authors.forename: P
authors.initials: P
authors.lastname: Lepage
authors.forename: J
authors.initials: J
authors.lastname: Batungwanayo
authors.forename: D G
authors.initials: DG
authors.lastname: Hitimana
authors.forename: H
authors.initials: H
authors.lastname: Taelman
authors.forename: J
authors.initials: J
authors.lastname: Bogaerts
authors.forename: F
authors.initials: F
authors.lastname: Boineau
authors.forename: P
authors.initials: P
authors.lastname: Van de Perre
authors.forename: A
authors.initials: A
authors.lastname: Simonon
mesh_terms: D000328:Adult; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000401:mortality; D018023:HIV Seronegativity; D006679:HIV Seropositivity; D006801:Humans; D012432:Rwanda