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HIV Progression and Predictors of Mortality in a Community-Based Cohort of Zambian Adults

Department of Medicine, University Teaching Hospital, Lusaka, Zambia, HIV Unit, Department of Dermatology and Venerology, Medical University Innsbruck, Austria, maria.kitchen{at}uki.ac.at

Maria A. Quigley, MSc

Department of Infectious and Tropical Diseases, London School of Hygiene and Topical Medicine, London, United Kingdom

Alwyn M. Mwinga, MD

Department of Medicine, University Teaching Hospital, Lusaka, Zambia

Dietmar Fuchs, PhD

Division of Biological Chemistry, Biocentre, Innsbruck Medical University, and Ludwig Boltzmann Institute of AIDS Research, Innsbruck, Austria

Ida M. Lisse, MD

Department of Epidemiology Research and Danish Epidemiology Science Center, Statens Seruminstitut, Denmark

John D. H. Porter, MD

Department of Infectious and Tropical Diseases, London School of Hygiene and Topical Medicine, London, United Kingdom

Keith P. W. J. McAdam, FRCP

Infectious Diseases Institute, Makerere University, Kampala, Uganda

Peter Godfrey-Faussett, FRCP

Department of Infectious and Tropical Diseases, London School of Hygiene and Topical Medicine, London, United Kingdom

This article describes immunological HIV progression, mortality, and its predictors in 974 Zambian adults. During 3138 person-years of follow-up, 281 deaths occurred, and the overall mortality rate was 9.0 per 100 person-years. Thirty-six percent of patients were dead within 5 years of enrollment. The median survival in patients with baseline CD4 count 500 cells/mm³ was 5.62 years, with CD4 count between 200 and 499 cells/mm³ 5.46 years, and with CD4 count <200 cells/mm³ 3.89 years. The mortality rate increased significantly with older age (6.9 in patients <25 years, 9.3 in individuals aged 25-39 years, 10.2 in patients 40 years) and was higher in women (rate ratio 1.29). The median annual change of progression markers was —29.6 cells/mm³ for CD4 count, —3.0% for CD4 count percentage, 1.2 nmol/L for neopterin, —1.9 g/L for hemoglobin, and —70 cells/ mm³ for total lymphocyte count. Hemoglobin and neopterin were as accurate as CD4 count to predict mortality.

Key Words: Africa • HIV progression • mortality • CD4 count • anemia • neopterin • gender

This version was published on February 1, 2008

Journal of the International Association of Physicians in AIDS Care (JIAPAC), Vol. 7, No. 1, 17-26 (2008)
DOI: 10.1177/1545109707303989


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