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 out-migration 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 (Cl) 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% Cl 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% Cl 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% Cl 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. (C) 2007 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.