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

OBJECTIVE: To estimate the survival time from HIV infection to death. METHODS: A community cohort in Rakai district, Uganda, identified 837 seroconverters followed annually between 1995 and 2003 until they died, were censored by outmigration or truncated on 31 December 2003 because antiretroviral treatment became available. HIV-1 subtype was determined by multiple hybridization assay for 396 seroconverters. The median interval from infection to death was estimated by Kaplan-Meier survival analyses and Weibull models. Hazard ratios (HR) and their 95% confidence intervals (CI) associated with survival were estimated using Cox proportional hazards modeling. RESULTS: There were 122 deaths over 2330 person-years (py), an average mortality of 5.2/100 py. The median survival time was 8.7 years (95% CI 8.1-9.3), and did not differ by sex, place of residence or time period of seroconversion. Survival time decreased significantly with older age at infection (P = 0.01). Survival was shorter with subtypes D, AD recombinant or multiple infections compared with subtype A (log rank P = 0.04), but this was of borderline significance after adjustment (adjusted HR 3.47, 95% CI 0.89-15.44, P = 0.07). Non-A subtypes constituted 84.6% of all identifiable infections and had a median survival time of 7.5 years (95% CI 6.4-8.5), whereas over 90% of those infected with subtype A were still alive 7 years post-infection. CONCLUSION: The median survival time in Rakai was shorter than reported in other African populations, and we hypothesize that this may be a result of the predominance of non-A subtypes with faster disease progression in this population.