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Time from HIV sero-conversion to death prior to ART: a collaborative analysis of eight studies in six developing countries

Todd J, Glynn JR, Marston M, Rangsin R, Lutalo T, Biraro S, Sonnenberg P, Mwita W, Nelson K, Fitzgerald D, Karita E and Zaba B.

AIDS.  2007  vol 21 sup 6: S55-S63

Objectives:To estimate survival patterns after HIV infection in adults in low and middle income countries.
Design: An analysis of pooled data from 8 different studies in 6 countries. 
Methods: HIV seroconverters were included from 8 studies (3 population-based, 2 occupational, and 3 clinic cohorts) if they were at least 15 years of age, and had no more than 4 years between last HIV negative and subsequent HIV positive test.  Four strata were defined:  East African cohorts; South African miner cohort; Thai cohorts; Haitian clinic cohort.   Kaplan-Meier functions were used to estimate survival patterns, and Weibull distributions to model and extend survival estimates.  Analyses examined the effect of site, age, and sex on survival.
Results: From 3823 eligible sero-converters, 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 at seroconversion, the median survival was longer in South African miners, 11.6 years (95% CI 9.8-13.7) and African population 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.

Conclusions: Without ART, overall survival following 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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