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
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Date
2006Author
Lavreys, L
Baeten, JM
Chohan, V
McClelland, RS
Hassan, WM
Richardson, BA
Mandaliya, K
Ndinya-Achola Jeckoniah O.
Overbaugh, J
Type
ArticleLanguage
enMetadata
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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.
CONCLUSION:
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
URI
http://www.ncbi.nlm.nih.gov/pubmed/16586394http://erepository.uonbi.ac.ke:8080/xmlui/handle/123456789/16645
Citation
Clin Infect Dis. 2006 May 1;42(9):1333-9Publisher
Department of Epidemiology, Medicine, and Biostatistics, University of Washington, Seattle, WA 98104-2499, USA Department of Medical Microbiology, University of Nairobi
Collections
- Faculty of Health Sciences (FHS) [10377]