Survival and progression of HIV disease in women attending GUM/HIV clinicsin Britain and Ireland

Objectives: To describe the pattern of clinical disease in women with HIV i nfection and to examine the effect of potential cofactors, including oral c ontraceptive use, alcohol and smelting, ethnic group, and route of HIV tran smission, on progression to AIDS and death. Design: Prospective observational cohort study. Setting: 15 HIV and genitourinary medicine (GUM) clinics in Britain and Ire land. Participants: 505 women aged over 18 years with a positive HIV antibody tes t entered the study between June 1992 and August 1995, with outcome data av ailable for 503 women, and 1208 woman years of follow up to April 1996. Main outcome measures: AIDS defining conditions, incidence of AIDS, and dea th. Results: 120 women (24%) had AIDS at entry to the study. There were 99 inci dent AIDS cases and 132 deaths during 1208 woman years of follow up. Pneumo cystis carinii pneumonia (PCP) was the commonest first AIDS defining condit ion in white women (31% of AIDS cases), followed by oesophageal candidiasis (19%) while tuberculosis was the most common first AIDS defining condition among black African women (24% of AIDS cases), followed by oesophageal can didiasis (19%). In multivariate analyses, rate of progression to AIDS was s ignificantly related to CD4 lymphocyte count at entry and PCP prophylaxis, but not to ethnic group, route of HIV transmission, alcohol, smoking, or or al contraceptive use. Mortality from all causes was not significantly diffe rent in women infected through injecting drugs (adjusted ratio 1.1, 95% con fidence interval 0.7-1.8) compared with those infected through sexual inter course, and non-significantly lower in black African women (0.7, 0.3-1.2) c ompared with white women. Survival was not significantly related to smoking , alcohol, or oral contraceptive use. Conclusions: In women attending GUM/HIV clinics, the pattern of AIDS defini ng conditions differs by ethnic group, but progression of HIV disease is no t importantly related to smoking, alcohol, oral contraceptive use, route of HIV transmission, or ethnic group.