AIDS in Africa--survival according to AIDS-defining illness.
OBJECTIVE
Evaluation of prognostic significance of the type of AIDS-defining illness (ADI) and performance status in a cohort of AIDS patients.


METHODS
A retrospective analysis of 280 patients with AIDS, as defined by the proposed World Health Organisation (WHO) clinical staging system, who attended two Cape Town-based HIV clinics between 1984 and 1997. Patients were stratified according to the type of initial ADI. Survival associated with each opportunistic event was determined by Kaplan-Meier analysis. Cox proportional hazard analysis was used to determine relative risk for death associated with three strata of ADI.


RESULTS
Median survival associated with various initial ADIs varied from less than 3 months (encephalopathy and wasting), to over 2 years (extrapulmonary tuberculosis and herpes simplex virus infection). This effect of ADI on outcome was most striking in patients with relatively preserved CD4 counts (CD4 > 50/microliter). A performance status score 4 predicted 50% mortality at 1 month, irrespective of co-morbidity.


CONCLUSIONS
The type of ADI is an important determinant of survival, particularly in patients with preserved CD4 counts. The stratification of patients by type of ADI and performance status may be useful in the management of patients with advanced HIV infection in resource-limited environments.
Post
F A
FA
Infectious Diseases Unit, University of Cape Town Lung Institute, Cape Town.
Badri
M
M
Wood
R
R
Maartens
G
G
D015526:AIDS Dementia Complex / Q000401:mortality; D017088:AIDS-Related Opportunistic Infections / Q000401:mortality; D000163:Acquired Immunodeficiency Syndrome / Q000145:classification / Q000175:diagnosis* / Q000401:mortality*; D000293:Adolescent; D000328:Adult; D000368:Aged; D018791:CD4 Lymphocyte Count; D005260:Female; D019247:HIV Wasting Syndrome / Q000401:mortality; D015276:Health Care Rationing; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012306:Risk; D013019:South Africa / Q000453:epidemiology; D016019:Survival Analysis