HIV-1 infection in rural Africa: is there a difference in median time to AIDS and survival compared with that in industrialized countries?

  title={HIV-1 infection in rural Africa: is there a difference in median time to AIDS and survival compared with that in industrialized countries?},
  author={Dilys Morgan and C{\'e}dric Mah{\'e} and Billy Nsubuga Mayanja and J M Okongo and Rosemary Lubega and James A Whitworth},
Objectives To describe the progression times of HIV-1 infection from seroconversion to AIDS and to death, and time from first developing AIDS to death in rural Uganda. Also, to describe the proportion of individuals within the cohort dying with AIDS and the CD4 lymphocyte count before death. Design A prospective, longitudinal, population-based cohort. Methods Since 1990, 107 HIV-prevalent cases, 168 incident cases and 235 HIV-seronegative controls have been recruited into a cohort in rural… 

HIV-1 disease progression and mortality before the introduction of highly active antiretroviral therapy in rural Uganda

HIV progression in this African cohort is similar to that reported in industrialized countries before the widespread introduction of ART, and older age at seroconversion was a risk factor for faster progression to death and ART eligibility.

Time from HIV seroconversion to death: a collaborative analysis of eight studies in six low and middle-income countries before highly active 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, but survival appears to be significantly worse in Thailand where other, unmeasured factors may affect progression.

The natural history of HIV-1 and HIV-2 infections in adults in Africa: a literature review.

The majority of patients in hospital in Africa with either HIV-1 or HIV-2 have the clinical features of AIDS just before they die, and many are severely immunosuppressed, similar to the situation in developed countries before the introduction of highly active antiretroviral therapy (HAART).

Survival from HIV-1 seroconversion in Southern Africa: a retrospective cohort study in nearly 2000 gold-miners over 10 years of follow-up

This study reports by far the largest cohort of individuals with known dates of seroconversion available in Africa, and survival pattern was similar to that seen in the West before antiretroviral therapy was available.

Survival after HIV infection in the pre-antiretroviral therapy era in a rural Tanzanian cohort

The survival of HIV-infected individuals in the Kisesa open cohort study was comparable to that reported in developed country studies before the introduction of HAART, and survival patterns are marginally more favourable than those reported in cohort studies in Uganda.

Migrants from Sub-Saharan Africa in the Swiss HIV Cohort Study: access to antiretroviral therapy, disease progression and survival

There is no evidence that access to potent antiretroviral therapy is influenced by geographic origin of participants, and the prognosis of Sub-Saharan African patients on triple therapy is equivalent to that of Northwest European patients.

The natural history of HIV-1 subtype E infection in young men in Thailand with up to 14 years of follow-up

The data indicate a more rapid progression to AIDS and death after HIV-1 infection among young Thai men than has been reported in similar aged men who were HAART-naive in western high income countries.

Survival of HIV-infected treatment-naive individuals with documented dates of seroconversion in Rakai, Uganda

The median survival time in Rakai was shorter than reported in other African populations, and it is hypothesize that this may be a result of the predominance of non-A subtypes with faster disease progression in this population.

Mortality of HIV-1, HIV-2 and HIV-1/HIV-2 dually infected patients in a clinic-based cohort in The Gambia

HIV-2-infected patients with CD4 cell counts of 500 cells/μl and greater had a significantly lower mortality rate than HIV-1- Infected patients, and HIV- 2- infected patients with advanced disease had the same poor prognosis as patients with HIV- 1.

Predictors of Mortality in a Cohort of HIV-1-Infected Adults in Rural Africa

HIV RNA level and CD4 cell count were found to predict mortality with prognostic capabilities similar to findings from high-income countries and might be considered candidates for alternative HIV progression markers.



HIV-1 disease progression and AIDS-defining disorders in rural Uganda

Disease progression and survival in HIV‐1‐infected Africans in London

Differences in progression to AIDS and death and CD4+ lymphocyte decline between HIV-1-infected Africans and non-Africans in London could not be attributed to ethnicity or different viral subtypes and were the major determinants of outcome.

HIV‐1 incidence and HIV‐1 ‐associated mortality in a rural Ugandan population cohort

These results demonstrate the profound impact that the HIV-1 epidemic has on adult mortality in a rural area of Uganda where theAIDS prevalence and incidence rates in adults are 8 and 1%, respectively.

Survival by AIDS defining condition in rural Uganda

The survival for most AIDS defining conditions was generally shorter and the median CD4 lymphocyte count higher than studies reported from developed countries, however, the conditions with the longest survival had a similar survival to that in developed countries and these conditions have a high background level in this population.

Predictors of mortality among HIV-infected women in Kigali, Rwanda.

Human immunodeficiency virus disease now accounts for 90% of all deaths among child-bearing urban Rwandan women and easy diagnosed signs and symptoms and inexpensive laboratory tests can be used in Africa to identify those patients with a particularly good or bad prognosis.

Four years of natural history of HIV-1 infection in african women: a prospective cohort study in Kigali (Rwanda), 1988-1993.

  • V. LeroyP. Msellati A. Simonon
  • Medicine
    Journal of acquired immune deficiency syndromes and human retrovirology : official publication of the International Retrovirology Association
  • 1995
Tuberculosis was a major cause of morbidity and mortality in these HIV+ African women and an early diagnosis and an appropriate treatment or prevention of tuberculosis should improve the quality of life of HIV-infected patients in Africa.

The AIDS incubation period in the UK estimated from a national register of HIV seroconverters

Preliminary results from the UK Register confirm the strong influence of age on disease progression in line with findings from a number of studies, and will continue to monitor the clinical course of HIV disease, including persons infected in the 1990s.

Determinants of HIV disease progression among homosexual men registered in the Tricontinental Seroconverter Study.

Younger age and use of prophylaxis against Pneumocystis carinii pneumonia were significantly related to slower progression from seroconversion to death, and an association between slower progression and earlier dates of serconversion was found.

HIV‐associated adult mortality in a rural Tanzanian population

This study confirms the strong association of HIV infection and mortality in rural Africa, with an annual death rate in adult seropositives of over 9%, and in this rural population with a relatively low HIV prevalence of 4%, HIV has increased overall adult mortality by more than 50%.