title: Baseline plasma viral load and CD4 cell percentage predict survival in HIV-1- and HIV-2-infected women in a community-based cohort in The Gambia.
abstract: OBJECTIVE
  To estimate and compare the all-cause mortality rates among HIV-1-infected, HIV-2-infected, and uninfected women and to assess the predictive value of baseline plasma viral load (PVL) and CD4 cell percentage (CD4%) for mortality.
  
  
  METHODS
  Cohort study.
  
  
  METHODS
  At presentation to antenatal clinics in The Gambia in 1993-1995, pregnant women were screened for antibodies to HIV-1 and HIV-2. Seropositive subjects and a similar number of seronegative controls were enrolled, and baseline PVL and CD4% were measured. Participants were visited regularly by field-workers until 18 months after delivery and again 4-7 years later.
  
  
  RESULTS
  Thirty-two of 101 women infected with HIV-1, 23 of 243 infected with HIV-2, and 9 of 468 seronegative women died during a median follow-up of 6.9 years. The mortality rate was 56 deaths per 1000 person years of observation (pyo) for HIV-1-infected, 16 deaths per 1000 pyo for HIV-2-infected, and 3.1 deaths per 1000 pyo for HIV-uninfected women. After 8 years of follow-up, >50% of HIV-1-infected women were still alive. In multivariate analysis, a 1-log increase of HIV-1 PVL was associated with a 1.8-fold higher rate of mortality (95% confidence interval [CI], 0.9-3.4). In HIV-2 infection, women with a high PVL (>10,000 copies/mL) had an 8.7-fold (95% CI, 2.8-28) higher rate of mortality than did those with a low PVL (<1000 copies/mL). A 10% decrease in CD4% was associated with higher mortality rates among HIV-1-infected (1.6-fold; 95% CI, 1.1-2.3) and HIV-2-infected (1.5-fold; 95% CI, 1.0-2.3) subjects.
  
  
  CONCLUSIONS
  Survival of HIV-1-infected women in The Gambia is similar to that in industrialized countries before the introduction of antiretroviral treatment. Survival of HIV-2-infected women is much better. However, women with high PVLs die as quickly as their HIV-1-infected counterparts.
authors.affiliation: MRC Laboratories, Fajara, The Gambia.
authors.forename: Andreas
authors.initials: A
authors.lastname: Hansmann
authors.forename: Maarten F
authors.initials: MF
authors.lastname: Schim van der Loeff
authors.forename: Steve
authors.initials: S
authors.lastname: Kaye
authors.forename: Akum Aveika
authors.initials: AA
authors.lastname: Awasana
authors.forename: Ramu
authors.initials: R
authors.lastname: Sarge-Njie
authors.forename: Diarmuid
authors.initials: D
authors.lastname: O'Donovan
authors.forename: Koya
authors.initials: K
authors.lastname: Ariyoshi
authors.forename: Abraham
authors.initials: A
authors.lastname: Alabi
authors.forename: Paul
authors.initials: P
authors.lastname: Milligan
authors.forename: Hilton C
authors.initials: HC
authors.lastname: Whittle
mesh_terms: D000293:Adolescent; D000328:Adult; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D005714:Gambia / Q000453:epidemiology; D015658:HIV Infections / Q000401:mortality* / Q000821:virology; D015497:HIV-1 / Q000502:physiology*; D015498:HIV-2 / Q000502:physiology*; D006801:Humans; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D015996:Survival Rate; D019562:Viral Load