An HIV-1 natural history cohort and survival times in rural Uganda

• Published in: AIDS (London) Vol. 11; no. 5; pp. 633 - 640
• Main Authors: MORGAN, D, MALAMBA, S. S, MAUDE, G. H, OKONGO, M. J, WAGNER, H.-U, MULDER, D. W, WHITWORTH, J. A
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01.04.1997
• Subjects: Adolescent; Adult; AIDS/HIV; Biological and medical sciences; Cohort Studies; Female; HIV Infections - epidemiology; HIV-1; Human immunodeficiency virus 1; Humans; Immunodeficiencies; Immunodeficiencies. Immunoglobulinopathies; Immunopathology; Male; Medical sciences; Middle Aged; Population; Prospective Studies; Tropical medicine; Uganda - epidemiology; Uganda; Africa; Human; Immunopathology; HIV-1 virus; Retroviridae; AIDS; Immune deficiency; Epidemiology; Survival; Infection; Virus; Viral disease; Rural area; Lentivirinae; Evolution; Human immunodeficiency virus; Measurement; Eastern Africa; Prevalence; Prospective Studies; Viral Diseases; Biology; Research Methodology; English Speaking Africa; Immunity; Incidence; Time Factors; Rural Population; Acquired Immunodeficiency Syndrome; Population Characteristics; Population; Research Report; Physiology; Demographic Factors; Mortality; Africa; Cohort Analysis; Hiv Infections; Seroconversion; Diseases; Studies; Uganda; Developing Countries; Africa South Of The Sahara; Population Dynamics
• ISSN: 0269-9370; 1473-5571
• DOI: 10.1097/00002030-199705000-00011

To describe a population-based rural cohort of HIV-1-seropositive and seronegative individuals established in 1990 in south-west Uganda, and determine survival times in the cohort. Prospective cohort study. Participants were recruited from a large population study, and invited to attend a clinic every 3 months. They were seen by clinicians who administered detailed medical questionnaires and undertook a physical examination. By the end of 1995, 390 (79%) of the 491 people asked to enrol in the natural history cohort (NHC) had done so. Ninety-three were prevalent cases of HIV infection detected during the initial survey round of the general population cohort in 1989/1990, 66 were subsequent incident cases, 177 were age-matched HIV-negative controls and 54 were HIV-negative spouses of HIV-positive individuals. Twenty participants seroconverted in the NHC. The age-standardized mortality rates per 1000 person-years for the prevalent, incident, and negative cases were 156.5 [95% confidence interval (CI), 115.8-211.4], 35.0 (95% CI, 16.4 75.0) and 13.5 (95% CI, 7.3-25.1), respectively. The median survival time from enrolment to death for the prevalent cases was 4.5 years (95% CI, 3.5- > 5.2); > 5.4 years from seroconversion for the incident cases; and > 5.2 years from enrolment for the HIV-negative cases. The 5-year cumulative survival for prevalents, incidents and HIV-negative participants was 46%, 83% and 94%, respectively. We have described an NHC of HIV-positive and HIV-negative participants which is representative of the general population. The NHC was established over 5 years ago; it is continuing and we are maintaining good compliance rates. Survival probabilities in the cohort were lower than most other reported studies.