Mortality of HIV-1, HIV-2 and HIV-1/HIV-2 dually infected patients in a clinic-based cohort in The Gambia.
OBJECTIVE
To assess and compare the mortality rates of patients with HIV-1, HIV-2 or both infections (HIV-D) in the same population.


METHODS
Clinic-based cohort study.


METHODS
HIV-seropositive patients aged 15 years and older who attended the Medical Research Council clinics in Fajara between May 1986 and September 1997 were recruited. Clinical assessment using the Karnofsky score, CDC cell staging, WHO staging, and CD4 cell counts was performed at baseline. Patients attended clinic every 3 months; if they did not attend, they were visited at home by field workers to ascertain survival status. No patient was on antiretroviral therapy during the study period.


RESULTS
Data from 1519 HIV-positive adult patients were analysed. A total of 746 patients had HIV-1, 666 HIV-2, and 107 patients had HIV-D. A total of 828 patients (55%) died, and 161 (11%) were lost to follow-up. The median follow-up was 12 months (range 0-128). CD4 cell counts were available for 894 patients. Compared with HIV-1, the adjusted hazards ratio for mortality in the CD4 cell count category 500 cells/microl or greater was 0.50 for HIV-2 (95% CI 0.28-0.88) and 1.27 (95% CI 0.51-3.7) for HIV-D. Among those with CD4 cell counts less than 500 cells/microl the mortality rates in HIV-2 and HIV-D were similar to those in HIV-1.


CONCLUSIONS
HIV-2-infected patients with CD4 cell counts of 500 cells/microl and greater had a significantly lower mortality rate than HIV-1-infected patients. HIV-2-infected patients with advanced disease had the same poor prognosis as patients with HIV-1. Dually infected patients had mortality rates similar to HIV-1.
Schim van der Loeff
Maarten F
MF
Medical Research Council Laboratories, Banjul, The Gambia. maarten.achim@Ishtm.ac.uk
Jaffar
Shabbar
S
Aveika
Akum A
AA
Sabally
Saihou
S
Corrah
Tumani
T
Harding
Elizabeth
E
Alabi
Abraham
A
Bayang
Alhajie
A
Ariyoshi
Koya
K
Whittle
Hilton C
HC
D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D018791:CD4 Lymphocyte Count; D002487:Centers for Disease Control and Prevention, U.S.; D015331:Cohort Studies; D005260:Female; D005714:Gambia / Q000453:epidemiology; D015658:HIV Infections / Q000150:complications / Q000401:mortality* / Q000821:virology; D015497:HIV-1; D015498:HIV-2; D006801:Humans; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D016019:Survival Analysis; D014481:United States; D014944:World Health Organization