Time from HIV seroconversion to death: a collaborative analysis of eight studies in six low and middle-income countries before highly active antiretroviral therapy.
OBJECTIVE
To estimate survival patterns after HIV infection in adults in low and middle-income countries.


METHODS
An analysis of pooled data from eight different studies in six countries.


METHODS
HIV seroconverters were included from eight studies (three population-based, two occupational, and three clinic cohorts) if they were at least 15 years of age, and had no more than 4 years between the last HIV-negative and subsequent HIV-positive test. Four strata were defined: East African cohorts; South African miners cohort; Thai cohorts; Haitian clinic cohort. Kaplan-Meier functions were used to estimate survival patterns, and Weibull distributions were used to model and extend survival estimates. Analyses examined the effect of site, age, and sex on survival.


RESULTS
From 3823 eligible seroconverters, 1079 deaths were observed in 19 671 person-years of follow-up. Survival times varied by age and by study site. Adjusting to age 25-29 years at seroconversion, the median survival was longer in South African miners: 11.6 years [95% confidence interval (CI) 9.8-13.7] and East African cohorts: 11.1 years (95% CI 8.7-14.2) than in Haiti: 8.3 years (95% CI 3.2-21.4) and Thailand: 7.5 years (95% CI 5.4-10.4). Survival was similar for men and women, after adjustment for age at seroconversion and site.


CONCLUSIONS
Without antiretroviral therapy, overall survival after HIV infection in African cohorts was similar to survival in high-income countries, with a similar pattern of faster progression at older ages at seroconversion. Survival appears to be significantly worse in Thailand where other, unmeasured factors may affect progression.
Todd
Jim
J
MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda. jim.todd@mrcuganda.org
Glynn
Judith R
JR
Marston
Milly
M
Lutalo
Tom
T
Biraro
Sam
S
Mwita
Wambura
W
Suriyanon
Vinai
V
Rangsin
Ram
R
Nelson
Kenrad E
KE
Sonnenberg
Pam
P
Fitzgerald
Dan
D
Karita
Etienne
E
Zaba
Basia
B
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D003906:Developing Countries / Q000191:economics / Q000706:statistics & numerical data; D018450:Disease Progression; D004812:Epidemiologic Methods; D005260:Female; D006679:HIV Seropositivity / Q000188:drug therapy / Q000401:mortality*; D006801:Humans; D008297:Male; D019562:Viral Load / Q000706:statistics & numerical data