HIV progression and predictors of mortality in a community-based cohort of Zambian adults
Kitchen, M.; Quigley, M.A.; Mwinga, A.M.; Fuchs, D.; Lisse, I.M.; Porter, J.D.H.; McAdam, K.P.W.J.; Godfrey-Faussett, P.
Journal of the International Association of Physicians in Aids Care 7(1): 17-26
2008
ISSN/ISBN: 1545-1097 PMID: 17989427 DOI: 10.1177/1545109707303989Document Number: 576859
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.