title: Low level viremia and high CD4% predict normal survival in a cohort of HIV type-2-infected villagers.
abstract: A community-based study of human immunodeficiency virus type 2 (HIV-2) infection was conducted in a rural village in northern Guinea Bissau, West Africa to assess the relationship between plasma HIV-2 RNA levels, CD4 lymphocyte percentage, and survival over an 8-year period. The cohort of 133 HIV-2-infected individuals and 160 HIV-uninfected controls enrolled in 1991 were followed up at home until 1998. Thirty-one (23%) HIV-2-infected and 24 (16%) HIV-uninfected individuals died over the follow-up period (mortality hazard ratio 1.7, 95% CI 1.0, 2.9; p= 0.06). In HIV-2-infected individuals, the median HIV-2 RNA level was 347 copies/ml and the mean CD4% was 28.6. Both plasma viremia and CD4% were independent predictors of survival, with hazard ratios increasing by 1.6 (95% CI, 1.1, 2.3) for each log(10) increase of plasma viremia and 1.7 (1.1, 2.6) for each 10% decrease of CD4%. Infected subjects with a plasma viral load >or= the median (347 copies/ml) and a CD4% <or= the mean (28.6%) had a mortality hazard ratio of 3.1 (95% CI 1.7, 5.8) compared to uninfected controls, whereas the remaining infected subjects had a mortality rate similar to uninfected controls, the mortality hazard ratio being 1.0 (95% CI, 0.5, 2.1.) In those who survived between 1991 and 1996, HIV-2 RNA levels were unchanged overall and CD4 lymphocyte counts remained high. In conclusion, baseline HIV-2 RNA levels predicted a normal survival for the majority, with low and stable levels of plasma viremia characterizing HIV-2 infections in this rural West African community.
authors.affiliation: Department of Virology, Royal Free and University College Medical School, London, UK.
authors.forename: Neil
authors.initials: N
authors.lastname: Berry
authors.forename: Shabbar
authors.initials: S
authors.lastname: Jaffar
authors.forename: Maarten
authors.initials: M
authors.lastname: Schim van der Loeff
authors.forename: Koya
authors.initials: K
authors.lastname: Ariyoshi
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Harding
authors.forename: Pa Tamba
authors.initials: PT
authors.lastname: N'Gom
authors.forename: Francisco
authors.initials: F
authors.lastname: Dias
authors.forename: Andrew
authors.initials: A
authors.lastname: Wilkins
authors.forename: Dominic
authors.initials: D
authors.lastname: Ricard
authors.forename: Peter
authors.initials: P
authors.lastname: Aaby
authors.forename: Richard
authors.initials: R
authors.lastname: Tedder
authors.forename: Hilton
authors.initials: H
authors.lastname: Whittle
mesh_terms: D000328:Adult; D000368:Aged; D018791:CD4 Lymphocyte Count; D016022:Case-Control Studies; D005260:Female; D006169:Guinea-Bissau; D015658:HIV Infections / Q000276:immunology / Q000503:physiopathology* / Q000821:virology; D015498:HIV-2 / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015996:Survival Rate; D019562:Viral Load