MORTALITY ASSOCIATED WITH HIV-1 INFECTION OVER 5 YEARS IN A RURAL UGANDAN POPULATION - COHORT STUDY

Objective: To assess the impact of HIV-1 infection on mortality over f ive years in a rural Ugandan population. Design: Longitudinal cohort s tudy followed up annually by a house to house census and medical surve y. Setting: Rural population in south west Uganda. Subjects: About 10 000 people from 15 villages who were enrolled in 1989-90 or later. Mai n outcome measures: Number of deaths from all causes, death rates, mor tality fraction attributable to HIV-1 infection. Results: Of 9777 peop le resident in the study area in 1989-90, 8833 (90%) had an unambiguou s result on testing for HIV-1 antibody; throughout the period of follo w up adult seroprevalence was about 8%. During 35 083 person years of follow up, 459 deaths occurred, 273 in seronegative subjects and 186 i n seropositive subjects, corresponding to standardised death rates of 8.1 and 129.3 per 1000 person years. Standardised death rates for adul ts were 10.4 (95% confidence interval 9.0 to 11.8) and 114.0 (93.2 to 134.8) per 1000 person years respectively, The mortality fraction attr ibutable to HIV-1 infection was 41% for adults and was in excess of 70 % for men aged 25-44 and women aged 20-44 years. Median survival from time of enrolment was less than three years in subjects aged 55 years or more who were infected with HIV-1. Life expectancy from birth in th e total population resident at any time was estimated to be 42.5 years (41.4 years in men; 43.5 years in women), which compares with 58.3 ye ars (56.5 years in men; 60.5 years in women) in people known to be ser onegative. Conclusions: These data confirm that in a rural African pop ulation HIV-1 infection is associated with high death rates and a subs tantial reduction in life expectancy.