Disease progression and survival in HIV-1-infected Africans in London.
OBJECTIVE
To examine differences in progression to AIDS and death between HIV-1-positive Africans (most infected in sub-Saharan Africa and therefore with non-B subtypes) and HIV-1-positive non-Africans in London.


METHODS
Retrospective cohort study of 2048 HIV-1-positive individuals.


METHODS
HIV-1-infected individuals attending 11 of the largest HIV/AIDS units in London.


METHODS
Subjects were 1056 Africans and 992 non-Africans seen between 1982-1995.


RESULTS
There were no differences in crude survival from presentation to death between Africans and non-Africans (median 82 and 78 months, respectively; P = 0.22). Africans progressed more rapidly to AIDS [hazard ratio (HR), 1.21; 95% confidence interval (CI), 1.02-1.45] but after adjustment for age, sex, Centers for Disease Control and Prevention category B symptoms and CD4+ lymphocyte count at presentation, year of HIV diagnosis and hospital attended, this difference was no longer significant (adjusted HR, 1.15; 95% CI, 0.93-1.43). Africans with AIDS had a reduced risk of death compared with non-Africans (HR, 0.78; 95% CI, 0.63-0.96) but not after adjustment for age, CD4+ lymphocyte count at AIDS, initial AIDS-defining conditions (ADC) and hospital attended (HR, 0.98; 95% CI, 0.76-1.27). Tuberculosis as the first ADC was associated with a 64% reduction in the risk of death. CD4+ lymphocyte decline was not significantly different between Africans and non-Africans (P = 0.18).


CONCLUSIONS
Differences in progression to AIDS and death and CD4+ lymphocyte decline between HIV-1-infected Africans and non-Africans in London could not be attributed to ethnicity or different viral subtypes. Age and the clinical and immunological stage at presentation, or AIDS, were the major determinants of outcome. Compared with other diagnoses, tuberculosis as the initial ADC was associated with increased survival. Lack of access to health care and exposure to environmental pathogens are the most likely causes of reduced survival with AIDS in Africa, rather than inherently different rates of progression of immune deficiency due to racial differences or viral subtypes.
Medical Research Council UK Centre for Co-ordinating Epidemiological Studies of HIV and AIDS, Department of Sexually Transmitted Diseases, Mortimer Market Centre, London.
J
J
Del Amo
A
A
Petruckevitch
A
A
Phillips
A M
AM
Johnson
J
J
Stephenson
N
N
Desmond
T
T
Hanscheid
N
N
Low
A
A
Newell
A
A
Obasi
K
K
Paine
A
A
Pym
C M
CM
Theodore
K M
KM
De Cock
D000163:Acquired Immunodeficiency Syndrome / Q000208:ethnology / Q000276:immunology / Q000401:mortality*; D000328:Adult; D000349:Africa / Q000208:ethnology; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D015497:HIV-1; D006801:Humans; D015994:Incidence; D008131:London / Q000453:epidemiology; D008297:Male; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors