BETA(2)-MICROGLOBULIN AS A PREDICTOR OF DEATH IN HIV-INFECTED WOMEN FROM KIGALI, RWANDA

Objective: To determine if beta(2)-microglobulin (beta(2)M) predicts d eath among HIV-infected African women. Design: Nested case-control stu dy. Setting: Kigali, Rwanda. Participants: Two hundred and five seropr evalent women known to be HIV-infected since 1986-1987; 67 of whom die d of HIV disease (cases) and 138 were alive (controls) as of November 1991. In addition, 128 women who seroconverted between 1986 and 1991. Main outcome measures: HIV serology, clinical signs and symptoms of HI V disease, hematology variables, and beta(2)M concentration. Results: beta(2)M concentration increased over time (P<0.001) in the seropreval ent women and seroconvertors. The average rate of beta(2)M increase in women who died was 0.5 compared with 0.3 mg/l/year in the vital, sero prevalent women (P=0.07). The strongest independent predictors of deat h were the rate of change of beta(2)M (mg/l/year) [odds ratio (OR), 3. 4; 95% confidence interval (CI), 1.7-6.8] and baseline beta(2)M concen tration (mg/l) [OR, 1.6; 95% CI, 1.2-2.1]. The rate of death for women with beta(2)M concentration greater than or equal to 7.0 mg/l and a r ate of change of beta(2)M greater than or equal to 0.4 mg/l/year was 7 .3 times higher than for women with beta(2)M concentration < 7.0 mg/l and a rate of change of beta(2)M of < 0.4 mg/l/year (95% CI, 3.1-17.2) . The estimated median time from seroconversion to death assuming a co nstant rate of change of beta(2)M was 10.6 years (95% CI, 9.9-11.2) fo r this cohort of HIV-infected women. Conclusions: Elevated beta(2)M an d a high rate of beta(2)M increase were strongly associated with morta lity among HIV-infected African women. Based on survival estimates usi ng the rate of change of beta(2)M, HIV-infected African women have sim ilar survival compared with HIV-infected adults in the United States.