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Baseline Plasma Viral Load and CD4 Cell Percentage Predict Survival in HIV-1- and HIV-2-Infected Women in a Community-Based Cohort in The Gambia

Hansmann, Andreas*†; Schim van der Loeff, Maarten F*‡; Kaye, Steve*; Awasana, Akum Aveika*; Sarge-Njie, Ramu*; O'Donovan, Diarmuid; Ariyoshi, Koya*∥; Alabi, Abraham*; Milligan, Paul*; Whittle, Hilton C*

JAIDS Journal of Acquired Immune Deficiency Syndromes: March 1st, 2005 - Volume 38 - Issue 3 - p 335-341
Epidemiology and Social Science

Objectives: To estimate and compare the all-cause mortality rates among HIV-1-infected, HIV-2-infected, and uninfected women and to assess the predictive value of baseline plasma viral load (PVL) and CD4 cell percentage (CD4%) for mortality.

Design: Cohort study.

Methods: At presentation to antenatal clinics in The Gambia in 1993-1995, pregnant women were screened for antibodies to HIV-1 and HIV-2. Seropositive subjects and a similar number of seronegative controls were enrolled, and baseline PVL and CD4% were measured. Participants were visited regularly by field-workers until 18 months after delivery and again 4-7 years later.

Results: Thirty-two of 101 women infected with HIV-1, 23 of 243 infected with HIV-2, and 9 of 468 seronegative women died during a median follow-up of 6.9 years. The mortality rate was 56 deaths per 1000 person years of observation (pyo) for HIV-1-infected, 16 deaths per 1000 pyo for HIV-2-infected, and 3.1 deaths per 1000 pyo for HIV-uninfected women. After 8 years of follow-up, >50% of HIV-1-infected women were still alive. In multivariate analysis, a 1-log increase of HIV-1 PVL was associated with a 1.8-fold higher rate of mortality (95% confidence interval [CI], 0.9-3.4). In HIV-2 infection, women with a high PVL (>10,000 copies/mL) had an 8.7-fold (95% CI, 2.8-28) higher rate of mortality than did those with a low PVL (<1000 copies/mL). A 10% decrease in CD4% was associated with higher mortality rates among HIV-1-infected (1.6-fold; 95% CI, 1.1-2.3) and HIV-2-infected (1.5-fold; 95% CI, 1.0-2.3) subjects.

Discussion: Survival of HIV-1-infected women in The Gambia is similar to that in industrialized countries before the introduction of antiretroviral treatment. Survival of HIV-2-infected women is much better. However, women with high PVLs die as quickly as their HIV-1-infected counterparts.

From *MRC Laboratories, Fajara, The Gambia; †Westfälische Wilhelms-Universität, Münster, Germany; ‡London School of Hygiene and Tropical Medicine, London, United Kingdom; §Department of Public Health, University College, Galway, Ireland; and ∥National Institute of Infectious Diseases, Tokyo, Japan.

Received for publication December 9, 2003; accepted May 6, 2004.

Funded by the Medical Research Council (MRC; United Kingdom) and the Japanese Foundation for AIDS Prevention. Maarten Schim van der Loeff was supported by an MRC-funded linked fellowship. Andreas Hansmann received a student travel award from Deutscher Akademischer Austausch Dienst.

Reprints: Maarten Schim van der Loeff, IATEC B.V., Pietersbergweg 9, 1105 BM, Amsterdam, The Netherlands (e-mail:

© 2005 Lippincott Williams & Wilkins, Inc.