title: Low CD4 T cell counts before HIV-1 seroconversion do not affect disease progression in Ethiopian factory workers.
abstract: 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.
authors.affiliation: Ethio-Netherlands AIDS Research Project, Ethiopian Health and Nutrition Research Institute, Addis Ababa, Ethiopia.
authors.forename: Yared
authors.initials: Y
authors.lastname: Mekonnen
authors.forename: Ronald B
authors.initials: RB
authors.lastname: Geskus
authors.forename: Jan C M
authors.initials: JC
authors.lastname: Hendriks
authors.forename: Tsehaynesh
authors.initials: T
authors.lastname: Messele
authors.forename: Jose
authors.initials: J
authors.lastname: Borghans
authors.forename: Frank
authors.initials: F
authors.lastname: Miedema
authors.forename: Dawit
authors.initials: D
authors.lastname: Wolday
authors.forename: Roel A
authors.initials: RA
authors.lastname: Coutinho
authors.forename: Nicole H T M
authors.initials: NH
authors.lastname: Dukers
mesh_terms: 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