title: Disease progression and survival following specific AIDS-defining conditions: a retrospective cohort study of 2048 HIV-infected persons in London.
abstract: 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.
authors.affiliation: Medical Research Council UK Centre for Coordinating Epidemiological Studies of HIV and AIDS, Department of Sexually Transmitted Diseases, University College London Medical School, UK.
authors.forename: A
authors.initials: A
authors.lastname: Petruckevitch
authors.forename: J
authors.initials: J
authors.lastname: Del Amo
authors.forename: A N
authors.initials: AN
authors.lastname: Phillips
authors.forename: A M
authors.initials: AM
authors.lastname: Johnson
authors.forename: J
authors.initials: J
authors.lastname: Stephenson
authors.forename: N
authors.initials: N
authors.lastname: Desmond
authors.forename: T
authors.initials: T
authors.lastname: Hanscheid
authors.forename: N
authors.initials: N
authors.lastname: Low
authors.forename: A
authors.initials: A
authors.lastname: Newell
authors.forename: A
authors.initials: A
authors.lastname: Obasi
authors.forename: K
authors.initials: K
authors.lastname: Paine
authors.forename: A
authors.initials: A
authors.lastname: Pym
authors.forename: C
authors.initials: C
authors.lastname: Theodore
authors.forename: K M
authors.initials: KM
authors.lastname: De Cock
mesh_terms: 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