DISEASE PROGRESSION AND SURVIVAL FOLLOWING SPECIFIC AIDS-DEFINING CONDITIONS - A RETROSPECTIVE COHORT STUDY OF 2048 HIV-INFECTED PERSONS INLONDON

Objective: To assess the impact of specific AIDS-defining conditions o n survival in HIV-infected persons, with emphasis on the effect of tub erculosis. Methods: A retrospective cohort analysis of HIV-infected Af ricans and non-Africans attending 11 specialist HIV/AIDS units in Lond on enrolled for a comparison of the natural history of HIV/AIDS in dif ferent ethnic groups. Results: A total of 2048 patients were studied o f whom 627 (31%) developed 1306 different AIDS indicator diseases. Pne umocystis carinii pneumonia accounted for 159 (25%) of initial AIDS ep isodes and tuberculosis for 103 (16%). In patients with HIV disease, t uberculosis had the lowest risk [relative risk (RR), 1.11; 95% confide nce interval (CI), 0.75-1.63], and high-grade lymphoma had the highest risk (RR, 20.56; 95% CI, 2.70-156.54) for death. For patients with a prior AIDS-defining illness, the development of subsequent AIDS indica tor diseases such as Pneumocystis carinii pneumonia (RR, 1.18; 95% CI, 0.77-1.83) and tuberculosis (RR, 1.36; 95% CI, 0.76-2.47) had the bes t survival, and non-Hodgkin's lymphoma had the worst survival (RR, 9.6 7; 95% CII 1.26-74.33). Patients with tuberculosis had a lower inciden ce of subsequent AIDS-defining conditions than persons with other init ial AIDS diagnoses (rate ratio, 0.47; 95% CI, 0.37-0.59). Conclusions: Considerable variation exists in the relative risk of death following different AIDS-defining conditions. The development of any subsequent AIDS-defining condition is associated with an increased risk of death that differs between diseases, and this risk should be considered whe n evaluating the impact of specific conditions. Like other AIDS-defini ng conditions, incident tuberculosis was associated with adverse outco me compared with the absence of an AIDS-defining event, but we found n o evidence of major acceleration of HIV disease attributable to tuberc ulosis. (C) 1998 Lippincott-Raven Publishers.