Low CD4 T cell counts before HIV-1 seroconversion do not affect disease progression in Ethiopian factory workers.
BACKGROUND
Human immunodeficiency virus type 1 (HIV-1)-uninfected Ethiopians have lower CD4 T cell counts than do other populations in Africa and industrialized countries. We studied whether this unique immunological profile results in shorter survival times in HIV-1-infected Ethiopians.


METHODS
Data from an open cohort study of 149 HIV-1-infected factory workers in Ethiopia for 1997-2002 were used. To estimate survival times, a continuous-time Markov model was designed on the basis of CD4 T cell counts and World Health Organization clinical staging. By use of a random-effects model, decline in CD4 T cell counts was compared between HIV-1-infected Ethiopian and Dutch individuals.


RESULTS
Median survival times were in the range of 9.1-13.7 years, depending on the approach used. This range is similar to that for populations in industrialized countries before the advent of antiretroviral therapy. Ethiopians had a lower annual decline in CD4 T cell counts than did Dutch individuals, which remained when groups with similar CD4 T cell count categories were compared. Moreover, the slower decline in CD4 T cell counts was not due merely to lower HIV-1 RNA loads or an absence of syncytium-inducing/X4 HIV-1 subtype C strains in Ethiopians.


CONCLUSIONS
Low baseline CD4 T cell counts do not imply shorter survival times in Ethiopians than in other populations, presumably because of a slower decline in CD4 T cell counts.
Mekonnen
Yared
Y
Ethio-Netherlands AIDS Research Project, Ethiopian Health and Nutrition Research Institute, Addis Ababa, Ethiopia.
Geskus
Ronald B
RB
Hendriks
Jan C M
JC
Messele
Tsehaynesh
T
Borghans
Jose
J
Miedema
Frank
F
Wolday
Dawit
D
Coutinho
Roel A
RA
Dukers
Nicole H T M
NH
D000328:Adult; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000166:cytology / Q000276:immunology* / Q000821:virology; D015331:Cohort Studies; D018450:Disease Progression; D005002:Ethiopia; D005260:Female; D015658:HIV Infections / Q000276:immunology* / Q000821:virology; D006679:HIV Seropositivity / Q000276:immunology* / Q000821:virology; D015497:HIV-1; D006801:Humans; D008297:Male; D008390:Markov Chains; D018448:Models, Immunological; D016019:Survival Analysis