Higher set point plasma viral load and more-severe acute HIV type 1 (HIV-1) illness predict mortality among high-risk HIV-1-infected African women.
BACKGROUND
There is limited information on the natural history of human immunodeficiency virus type 1 (HIV-1) infection in Africa, especially from individuals with well-defined dates of infection. We used data from a prospective cohort study of female sex workers in Mombasa, Kenya, who were followed up monthly from before the date of HIV-1 infection.


METHODS
Antiretroviral-naive women who had a well-defined date of HIV-1 infection were included in this analysis. The effects of set point plasma viral load (measured 4-24 months after infection), early CD4+ cell count, and symptoms of acute HIV-1 infection on mortality were assessed using Cox proportional hazards analysis.


RESULTS
Among 218 women, the median duration of follow-up after HIV-1 infection was 4.6 years. Forty women died, and at 8.7 years (the time of the last death), the cumulative survival rate was 51% by Kaplan-Meier analysis. Higher set point viral load, lower early CD4+ cell count, and more-symptomatic acute HIV-1 illness each predicted death. In multivariate analysis, set point viral load (hazard ratio [HR], 2.28 per 1 log10 copies/mL increase; P=.001) and acute HIV-1 illness (HR, 1.14 per each additional symptom; P=.05) were independently associated with higher mortality.


CONCLUSIONS
Among this group of African women, the survival rate was similar to that for HIV-1-infected individuals in industrialized nations before the introduction of combination antiretroviral therapy. Higher set point viral load and more-severe acute HIV-1 illness predicted faster progression to death. Early identification of individuals at risk for rapid disease progression may allow closer clinical monitoring, including timely initiation of antiretroviral treatment.
Department of Epidemiology, Medicine, and Biostatistics, University of Washington, Seattle, WA 98104-2499, USA. llavreys@u.washington.edu
Ludo
L
Lavreys
Jared M
JM
Baeten
Varsha
V
Chohan
R Scott
RS
McClelland
Wisal M
WM
Hassan
Barbra A
BA
Richardson
Kishorchandra
K
Mandaliya
Jeckoniah O
JO
Ndinya-Achola
Julie
J
Overbaugh
D000328:Adult; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000401:mortality*; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D012307:Risk Factors; D019562:Viral Load