Disease progression and survival following specific AIDS-defining conditions: a retrospective cohort study of 2048 HIV-infected persons in London.
OBJECTIVE
To assess the impact of specific AIDS-defining conditions on survival in HIV-infected persons, with emphasis on the effect of tuberculosis.


METHODS
A retrospective cohort analysis of HIV-infected Africans and non-Africans attending 11 specialist HIV/AIDS units in London enrolled for a comparison of the natural history of HIV/AIDS in different ethnic groups.


RESULTS
A total of 2048 patients were studied of whom 627 (31%) developed 1306 different AIDS indicator diseases. Pneumocystis carinii pneumonia accounted for 159 (25%) of initial AIDS episodes and tuberculosis for 103 (16%). In patients with HIV disease, tuberculosis had the lowest risk [relative risk (RR), 1.11; 95% confidence interval (CI), 0.75-1.63], and high-grade lymphoma had the highest risk (RR, 20.56; 95% CI, 2.70-156.54) for death. For patients with a prior AIDS-defining illness, the development of subsequent AIDS indicator diseases such as Pneumocystis carinii pneumonia (RR, 1.18; 95% CI, 0.77-1.83) and tuberculosis (RR, 1.36; 95% CI, 0.76-2.47) had the best survival, and non-Hodgkin's lymphoma had the worst survival (RR, 9.67; 95% CI, 1.26-74.33). Patients with tuberculosis had a lower incidence of subsequent AIDS-defining conditions than persons with other initial AIDS diagnoses (rate ratio, 0.47; 95% CI, 0.37-0.59).


CONCLUSIONS
Considerable variation exists in the relative risk of death following different AIDS-defining conditions. The development of any subsequent AIDS-defining condition is associated with an increased risk of death that differs between diseases, and this risk should be considered when evaluating the impact of specific conditions. Like other AIDS-defining conditions, incident tuberculosis was associated with adverse outcome compared with the absence of an AIDS-defining event, but we found no evidence of major acceleration of HIV disease attributable to tuberculosis.
Petruckevitch
A
A
Medical Research Council UK Centre for Coordinating Epidemiological Studies of HIV and AIDS, Department of Sexually Transmitted Diseases, University College London Medical School, UK.
Del Amo
J
J
Phillips
A N
AN
Johnson
A M
AM
Stephenson
J
J
Desmond
N
N
Hanscheid
T
T
Low
N
N
Newell
A
A
Obasi
A
A
Paine
K
K
Pym
A
A
Theodore
C
C
De Cock
K M
KM
D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology / Q000401:mortality; D000163:Acquired Immunodeficiency Syndrome / Q000150:complications / Q000401:mortality* / Q000503:physiopathology*; D000328:Adult; D015331:Cohort Studies; D018450:Disease Progression; D005500:Follow-Up Studies; D006801:Humans; D008131:London / Q000453:epidemiology; D012189:Retrospective Studies; D017741:Survivors