title: Modified Kigali combined staging predicts risk of mortality in HIV-infected adults in Lusaka, Zambia.
abstract: We assessed the utility of the modified Kigali combined (MKC) staging system for predicting survival in HIV-infected Zambian adults in a prospective, longitudinal, open cohort. From 1995 to 2004, HIV-discordant couples (one HIV-infected partner and one HIV-negative partner) were recruited from couples' voluntary counseling and testing centers in Lusaka, Zambia and followed at 3-month intervals. MKC stage, which incorporates clinical stage with erythrocyte sedimentation rate (ESR), hematocrit, and body mass index (BMI), was determined at enrollment. Kaplan-Meier survival and Cox proportional hazard methods were used to calculate median survival and relative hazards. We enrolled 1479 HIV-discordant couples with a combined 7305 person-years of follow-up. Among HIV-infected participants over the 9-year study period, there were 333 confirmed deaths. The time to 50% mortality was 8.5 years with MKC stage 1 and 2 disease compared to 3.7 years with MKC stage 4 disease at enrollment. Survival rates at 3 years were 85% with MKC stage 1 and 2 disease, 74% with MKC stage 3 disease, and 51% with MKC stage 4 disease. A total of 275 HIV-negative partners seroconverted during follow-up. In comparison, survival rates at 3 years were 94% for HIV-negative participants and 92% for participants who seroconverted during follow-up. In multivariate analysis, MKC stage 4 disease (HR = 3.7, 95% CI = 2.7-5.0) remained a strong predictor of mortality. Incorporating ESR, hematocrit, and BMI with clinical staging is a powerful, low-cost tool to identify HIV-infected adults at high risk for mortality.
authors.affiliation: Division of Infectious Diseases, Emory University, Atlanta, Georgia 30030, USA. pjpeters@cdc.gov
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Peters
authors.forename: Isaac
authors.initials: I
authors.lastname: Zulu
authors.forename: Nzali G
authors.initials: NG
authors.lastname: Kancheya
authors.forename: Shabir
authors.initials: S
authors.lastname: Lakhi
authors.forename: Elwyn
authors.initials: E
authors.lastname: Chomba
authors.forename: Cheswa
authors.initials: C
authors.lastname: Vwalika
authors.forename: Dhong-Jin
authors.initials: DJ
authors.lastname: Kim
authors.forename: Ilene
authors.initials: I
authors.lastname: Brill
authors.forename: Jareen
authors.initials: J
authors.lastname: Meinzen-Derr
authors.forename: Amanda
authors.initials: A
authors.lastname: Tichacek
authors.forename: Susan A
authors.initials: SA
authors.lastname: Allen
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D001799:Blood Sedimentation; D015992:Body Mass Index; D015331:Cohort Studies; D018572:Disease-Free Survival; D005191:Family Characteristics; D005260:Female; D015658:HIV Infections / Q000401:mortality / Q000517:prevention & control*; D015497:HIV-1; D015498:HIV-2; D006400:Hematocrit; D006801:Humans; D008297:Male; D011336:Probability; D012307:Risk Factors; D015996:Survival Rate; D014505:Urban Population; D015024:Zambia / Q000453:epidemiology