AEGiS-14IAC: Mortality rate in HIV-1 is 4-fold higher than in HIV-2: results from a long-term follow-up study of women in The Gambia.

14th International AIDS Conference

Barcelona, Spain - July 7-12, 2002

Mortality rate in HIV-1 is 4-fold higher than in HIV-2: results from a long-term follow-up study of women in The Gambia.

Int Conf AIDS 2002 Jul 7-12; 14:(abstract no. C10695)

Hansmann A, Schim van der Loeff MF, Akum AA, O'Donovan D, Ariyoshi K, Milligan P, Whittle H
MRC Laboratories The Gambia, Fajara, Gambia

BACKGROUND: There are few community-based, long-term follow-up studies in Africa, comparing the mortality rates in adults infected with HIV-1 or HIV-2 with uninfected adults. It is hypothesised that, like in HIV-1 infection, baseline plasma viral load (pvl) and CD4% predict subsequent mortality in HIV-2 infected adults.

METHODS: In 1993-5, 822 pregnant women throughout The Gambia were enrolled into a cohort studying perinatal transmission. 101 women had HIV-1, 243 HIV-2 and 10 HIV-1 and HIV-2 (HIV-D) infection and 468 were seronegative. The original study closed 18 months post-delivery. (O'Donovan, AIDS 2000, 14:441-448) These women were revisited by fieldworkers 4-7 years later to establish their survival status. On enrollment, CD4% and pvl in a subgroup were measured.

RESULTS: During a median follow-up period of 7.1 years, 34/101 HIV-1, 23/243 HIV-2, 1/10 HIV-D and 9/468 seronegative women died. The mortality rate was 58.1/1000 person-years-of-observation (pyo) in HIV-1, 15.3 in HIV-2, 15.6 in HIV-D and 3.1 in seronegative women. The crude HIV-2 mortality rate was 5.0 fold higher than that in HIV negative women (p<0.0005). The HIV-1 mortality rate was 18.9 times higher (p<0.0005). The mortality rate in HIV-2 was 3.8 fold lower (p<0.0005) than that in HV-1. After adjusting for age, an increase of 1 log in pvl was associated with a 1.9-fold increase in mortality rate (p = 0.04) in HIV-1, and a 2.1-fold increase (p = 0.15) in HIV-2. Each one percent decrease in CD4% was associated with a 1.04-fold increase in mortality rate (p = 0.054) in HIV-1 and a 1.06-fold increase (p = 0.07) in HIV-2.

CONCLUSIONS: Mortality in HIV-2 is 5-fold higher than in seronegative women, but only 1/4 of that in HIV-1 infected women. Plasma viral load is an independent and significant predictor of mortality in HIV-1 infected women in West Africa.

Keywords: AEGIS, HIV-2, HIV-1, Longitudinal Studies, Follow-Up Studies, HIV Infections, Viral Load, Acquired Immunodeficiency Syndrome, HIV Seropositivity, Survival Rate, Gambia, Africa, Human, Female, Adult, Pregnancy, Mortality

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