Long-term follow-up of HIV-positive and HIV-negative individuals in rural Malawi.
OBJECTIVE
To measure the effect of HIV on survival in rural Africa.


METHODS
A retrospective cohort study with more than 10 years follow-up.


METHODS
Individuals with known HIV status in the 1980s were identified from previous population surveys in Karonga District, northern Malawi. Follow-up studies were conducted in 1998-2000 to trace 197 HIV-positive and 396 age-sex-matched HIV-negative individuals and their spouses.


RESULTS
Information was obtained on all but 11 index individuals. Half (302) were found and the others were reported to have died (161) or to be alive outside the district (119). Ten year survival was 36% in the HIV-positive cohort and 90% in the initially HIV-negative cohort. The death rate was 93.3 per 1000 person-years in the HIV-positive individuals, and 11.3 in the initially HIV-negative individuals. Survival time since the initial test in HIV-positive individuals decreased with age, but relative survival, compared with HIV-negative individuals, was similar across age groups. The effect of HIV on survival was similar in men and women. Spouses of HIV-positive individuals had four times the mortality rate, and among survivors, four times the HIV prevalence, of spouses of initially HIV-negative individuals.


CONCLUSIONS
HIV-infected individuals had very high mortality rates, but one-third were still alive at 10 years. This is consistent with median survival from seroconversion being similar to that found in developed countries before antiretroviral therapy. Mortality rates in HIV-positive individuals increased with age, but relative mortality changed little with age.
Crampin
Amelia C
AC
Karonga Prevention Study, PO Box 46, Chilumba, Malawi.
Floyd
Sian
S
Glynn
Judith R
JR
Sibande
Felix
F
Mulawa
Dominic
D
Nyondo
Andrew
A
Broadbent
Philip
P
Bliss
Lyn
L
Ngwira
Bagrey
B
Fine
Paul E M
PE
D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology / Q000401:mortality*; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006679:HIV Seropositivity / Q000453:epidemiology / Q000401:mortality*; D006801:Humans; D008295:Malawi / Q000453:epidemiology; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D011159:Population Surveillance; D016016:Proportional Hazards Models; D012737:Sex Factors; D018454:Spouses; D016019:Survival Analysis; D015996:Survival Rate