HIV progression and predictors of mortality in a community-based cohort of Zambian adults.
This article describes immunological HIV progression, mortality, and its predictors in 974 Zambian adults. During 3138 person-years of follow-up, 281 deaths occurred, and the overall mortality rate was 9.0 per 100 person-years. Thirty-six percent of patients were dead within 5 years of enrollment. The median survival in patients with baseline CD4 count ≥500 cells/mm³ was 5.62 years, with CD4 count between 200 and 499 cells/mm³ 5.46 years, and with CD4 count <200 cells/mm³ 3.89 years. The mortality rate increased significantly with older age (6.9 in patients <25 years, 9.3 in individuals aged 25-39 years, 10.2 in patients ≥40 years) and was higher in women (rate ratio 1.29). The median annual change of progression markers was -29.6 cells/mm³ for CD4 count, -3.0% for CD4 count percentage, 1.2 nmol/L for neopterin, -1.9 g/L for hemoglobin, and -70 cells/mm³ for total lymphocyte count. Hemoglobin and neopterin were as accurate as CD4 count to predict mortality.
Kitchen
Maria
M
Department of Medicine, University Teaching Hospital, Lusaka, Zambia. maria.kitchen@uki.ac.at
Quigley
Maria A
MA
Mwinga
Alwyn M
AM
Fuchs
Dietmar
D
Lisse
Ida M
IM
Porter
John D H
JD
McAdam
Keith P W J
KP
Godfrey-Faussett
Peter
P
D000328:Adult; D017677:Age Distribution; D000740:Anemia / Q000097:blood; D015415:Biomarkers; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000276:immunology* / Q000401:mortality*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D019798:Neopterin / Q000097:blood; D011379:Prognosis; D017678:Sex Distribution; D015024:Zambia / Q000453:epidemiology
D015415:Biomarkers; D019798:Neopterin