n Southern African Journal of HIV Medicine - The spectrum and prognosis of AIDS-defining illnesses in Cape Town

Volume 2005, Issue 19
  • ISSN : 1608-9693
  • E-ISSN: 2078-6751



&lt;I&gt;Objectives.&lt;/I&gt; To describe the incidence, spectrum and prognosis of AIDS-defining illnesses (ADI) in patients without access to antiretroviral therapy (ART). &lt;BR&gt;&lt;I&gt;Design.&lt;/I&gt; Prospective cohort study. &lt;BR&gt;&lt;I&gt;Subjects.&lt;/I&gt; 1 215 HIV-infected patients attending adult HIV clinics affiliated to the University of Cape Town in the New Somerset and Groote Schuur Hospitals from 1992 to 2000. <BR><I>Main outcome measures.&lt;/I&gt; Incidence rate (IR) of ADIs and survival after the development of ADI. &lt;BR&gt;&lt;I&gt;Results.&lt;/I&gt; During follow-up, 430 ADIs occurred (IR = 21.3 cases per 100 patient-years (PYs)). IR varied according to CD4 count, with 38.8, 17.0 and 8.52 cases/100 PYs in patients with CD4 counts < 200 cells/µl, 200 - 350 cells/µl and > 350 cells/µl, respectively. Tuberculosis (TB) was the commonest ADI, followed by candidiasis of the oesophagus/trachea/bronchi. IRs for chronic herpes simplex ulcers, HIV wasting, <I>Pneumocystis carinii&lt;/I&gt; pneumonia and Kaposi's sarcoma were > 1.00 cases/100 PYs. TB was diagnosed in all CD4 strata, and was the only illness to occur commonly above 200 cells/µl. The median CD4 counts within 6 months of diagnosis of ADI ranged from 138 cells/µl for TB to 17 cells/µl for cryptococcosis. Overall, median time to death from date of diagnosis was 18 months, and ranged from 24.1 months for patients diagnosed with TB to 6 months for those diagnosed with cytomegalovirus. &lt;BR&gt;&lt;I&gt;Conclusions.&lt;/I&gt; HIV-infected patients with no access to ART in Cape Town are at high risk of AIDS-defining illnesses. This study provides useful data for designing therapeutic interventions for preventing these infections.

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