Time from HIV seroconversion to death: A collaborative analysis of eight studies in six low and middle-income countries before highly active antiretroviral therapy

Jim Todd, Judith R. Glynn, Milly Marston, Tom Lutalo, Sam Biraro, Wambura Mwita, Vinai Suriyanon, Ram Rangsin, Kenrad Edwin Nelson, Pam Sonnenberg, Dan Fitzgerald, Etienne Karita, Basia Zaba

Research output: Contribution to journalArticle

Abstract

OBJECTIVES: To estimate survival patterns after HIV infection in adults in low and middle-income countries. DESIGN: An analysis of pooled data from eight different studies in six countries. METHODS: HIV seroconverters were included from eight studies (three population-based, two occupational, and three clinic cohorts) if they were at least 15 years of age, and had no more than 4 years between the last HIV-negative and subsequent HIV-positive test. Four strata were defined: East African cohorts; South African miners cohort; Thai cohorts; Haitian clinic cohort. Kaplan-Meier functions were used to estimate survival patterns, and Weibull distributions were used to model and extend survival estimates. Analyses examined the effect of site, age, and sex on survival. RESULTS: From 3823 eligible seroconverters, 1079 deaths were observed in 19 671 person-years of follow-up. Survival times varied by age and by study site. Adjusting to age 25-29 years at seroconversion, the median survival was longer in South African miners: 11.6 years [95% confidence interval (CI) 9.8-13.7] and East African cohorts: 11.1 years (95% CI 8.7-14.2) than in Haiti: 8.3 years (95% CI 3.2-21.4) and Thailand: 7.5 years (95% CI 5.4-10.4). Survival was similar for men and women, after adjustment for age at seroconversion and site. CONCLUSION: Without 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. Survival appears to be significantly worse in Thailand where other, unmeasured factors may affect progression.

Original languageEnglish (US)
JournalAIDS
Volume21
Issue numberSUPPL. 6
DOIs
StatePublished - Nov 2007

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HIV Seropositivity
Highly Active Antiretroviral Therapy
Survival
Confidence Intervals
HIV
Thailand
HIV Infections
Haiti

Keywords

  • Africa
  • HIV seroconversion
  • Pre-HAART
  • Resource-poor countries
  • Survival

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology

Cite this

Time from HIV seroconversion to death : A collaborative analysis of eight studies in six low and middle-income countries before highly active antiretroviral therapy. / Todd, Jim; Glynn, Judith R.; Marston, Milly; Lutalo, Tom; Biraro, Sam; Mwita, Wambura; Suriyanon, Vinai; Rangsin, Ram; Nelson, Kenrad Edwin; Sonnenberg, Pam; Fitzgerald, Dan; Karita, Etienne; Zaba, Basia.

In: AIDS, Vol. 21, No. SUPPL. 6, 11.2007.

Research output: Contribution to journalArticle

Todd, J, Glynn, JR, Marston, M, Lutalo, T, Biraro, S, Mwita, W, Suriyanon, V, Rangsin, R, Nelson, KE, Sonnenberg, P, Fitzgerald, D, Karita, E & Zaba, B 2007, 'Time from HIV seroconversion to death: A collaborative analysis of eight studies in six low and middle-income countries before highly active antiretroviral therapy', AIDS, vol. 21, no. SUPPL. 6. https://doi.org/10.1097/01.aids.0000279707.01557.b2
Todd, Jim ; Glynn, Judith R. ; Marston, Milly ; Lutalo, Tom ; Biraro, Sam ; Mwita, Wambura ; Suriyanon, Vinai ; Rangsin, Ram ; Nelson, Kenrad Edwin ; Sonnenberg, Pam ; Fitzgerald, Dan ; Karita, Etienne ; Zaba, Basia. / Time from HIV seroconversion to death : A collaborative analysis of eight studies in six low and middle-income countries before highly active antiretroviral therapy. In: AIDS. 2007 ; Vol. 21, No. SUPPL. 6.
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abstract = "OBJECTIVES: To estimate survival patterns after HIV infection in adults in low and middle-income countries. DESIGN: An analysis of pooled data from eight different studies in six countries. METHODS: HIV seroconverters were included from eight studies (three population-based, two occupational, and three clinic cohorts) if they were at least 15 years of age, and had no more than 4 years between the last HIV-negative and subsequent HIV-positive test. Four strata were defined: East African cohorts; South African miners cohort; Thai cohorts; Haitian clinic cohort. Kaplan-Meier functions were used to estimate survival patterns, and Weibull distributions were used to model and extend survival estimates. Analyses examined the effect of site, age, and sex on survival. RESULTS: From 3823 eligible seroconverters, 1079 deaths were observed in 19 671 person-years of follow-up. Survival times varied by age and by study site. Adjusting to age 25-29 years at seroconversion, the median survival was longer in South African miners: 11.6 years [95{\%} confidence interval (CI) 9.8-13.7] and East African cohorts: 11.1 years (95{\%} CI 8.7-14.2) than in Haiti: 8.3 years (95{\%} CI 3.2-21.4) and Thailand: 7.5 years (95{\%} CI 5.4-10.4). Survival was similar for men and women, after adjustment for age at seroconversion and site. CONCLUSION: Without 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. Survival appears to be significantly worse in Thailand where other, unmeasured factors may affect progression.",
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AU - Todd, Jim

AU - Glynn, Judith R.

AU - Marston, Milly

AU - Lutalo, Tom

AU - Biraro, Sam

AU - Mwita, Wambura

AU - Suriyanon, Vinai

AU - Rangsin, Ram

AU - Nelson, Kenrad Edwin

AU - Sonnenberg, Pam

AU - Fitzgerald, Dan

AU - Karita, Etienne

AU - Zaba, Basia

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N2 - OBJECTIVES: To estimate survival patterns after HIV infection in adults in low and middle-income countries. DESIGN: An analysis of pooled data from eight different studies in six countries. METHODS: HIV seroconverters were included from eight studies (three population-based, two occupational, and three clinic cohorts) if they were at least 15 years of age, and had no more than 4 years between the last HIV-negative and subsequent HIV-positive test. Four strata were defined: East African cohorts; South African miners cohort; Thai cohorts; Haitian clinic cohort. Kaplan-Meier functions were used to estimate survival patterns, and Weibull distributions were used to model and extend survival estimates. Analyses examined the effect of site, age, and sex on survival. RESULTS: From 3823 eligible seroconverters, 1079 deaths were observed in 19 671 person-years of follow-up. Survival times varied by age and by study site. Adjusting to age 25-29 years at seroconversion, the median survival was longer in South African miners: 11.6 years [95% confidence interval (CI) 9.8-13.7] and East African cohorts: 11.1 years (95% CI 8.7-14.2) than in Haiti: 8.3 years (95% CI 3.2-21.4) and Thailand: 7.5 years (95% CI 5.4-10.4). Survival was similar for men and women, after adjustment for age at seroconversion and site. CONCLUSION: Without 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. Survival appears to be significantly worse in Thailand where other, unmeasured factors may affect progression.

AB - OBJECTIVES: To estimate survival patterns after HIV infection in adults in low and middle-income countries. DESIGN: An analysis of pooled data from eight different studies in six countries. METHODS: HIV seroconverters were included from eight studies (three population-based, two occupational, and three clinic cohorts) if they were at least 15 years of age, and had no more than 4 years between the last HIV-negative and subsequent HIV-positive test. Four strata were defined: East African cohorts; South African miners cohort; Thai cohorts; Haitian clinic cohort. Kaplan-Meier functions were used to estimate survival patterns, and Weibull distributions were used to model and extend survival estimates. Analyses examined the effect of site, age, and sex on survival. RESULTS: From 3823 eligible seroconverters, 1079 deaths were observed in 19 671 person-years of follow-up. Survival times varied by age and by study site. Adjusting to age 25-29 years at seroconversion, the median survival was longer in South African miners: 11.6 years [95% confidence interval (CI) 9.8-13.7] and East African cohorts: 11.1 years (95% CI 8.7-14.2) than in Haiti: 8.3 years (95% CI 3.2-21.4) and Thailand: 7.5 years (95% CI 5.4-10.4). Survival was similar for men and women, after adjustment for age at seroconversion and site. CONCLUSION: Without 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. Survival appears to be significantly worse in Thailand where other, unmeasured factors may affect progression.

KW - Africa

KW - HIV seroconversion

KW - Pre-HAART

KW - Resource-poor countries

KW - Survival

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