HIV-1 infection in rural Africa: is there a difference in median time to AIDS and survival compared with that in industrialized countries?
OBJECTIVE
To describe the progression times of HIV-1 infection from seroconversion to AIDS and to death, and time from first developing AIDS to death in rural Uganda. Also, to describe the proportion of individuals within the cohort dying with AIDS and the CD4 lymphocyte count before death.


METHODS
A prospective, longitudinal, population-based cohort.


METHODS
Since 1990, 107 HIV-prevalent cases, 168 incident cases and 235 HIV-seronegative controls have been recruited into a cohort in rural Uganda. Participants are recruited from the general population and they are reviewed routinely every 3 months and at other times when ill.


RESULTS
The median time from seroconversion to death was 9.8 years. Age over 40 years at seroconversion was associated with more rapid progression (P < 0.001, log rank test). For the first 4 years of the study, HIV contributed little to the death rates in the HIV incident cases, but after 5 years, the contribution of HIV became greater and was particularly marked in the oldest age group. Survival rates in the cohort were similar to those in the general population. The median time from seroconversion to AIDS was 9.4 years and from AIDS to death was 9.2 months. Of those infected with HIV-1, 80% died with AIDS and 20% had a CD4 count < 10 x 106 cells/l.


CONCLUSIONS
Survival with HIV-1 infection is similar in Africa to industrialized countries before the use of antiretroviral therapy; when they do die, many of those in Africa are severely immunosuppressed and most have clinical features of AIDS.
Morgan
Dilys
D
Medical Research Council Programme on AIDS, Uganda Virus Research Institute, Entebbe, Uganda.
Mahe
Cedric
C
Mayanja
Billy
B
Okongo
J Martin
JM
Lubega
Rosemary
R
Whitworth
James A G
JA
D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology / Q000276:immunology / Q000401:mortality / Q000503:physiopathology; D000293:Adolescent; D000328:Adult; D019049:Developed Countries; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000276:immunology / Q000401:mortality* / Q000503:physiopathology; D006679:HIV Seropositivity / Q000453:epidemiology / Q000276:immunology / Q000401:mortality / Q000503:physiopathology; D015497:HIV-1; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012424:Rural Population; D013997:Time Factors; D014454:Uganda / Q000453:epidemiology