Immunologic and clinical stages in HIV-1-infected Ugandan adults are comparable and provide no evidence of rapid progression but poor survival with advanced disease

Clear understanding of the natural history of HIV-I disease is critical for planning and developing appropriate therapeutic strategies for HIV-l-infec ted populations in the developing world. Present knowledge about Africa is based on very limited data that largely use clinical staging as the prognos tic marker; this approach has not been prospectively validated. Our objecti ves were to compare clinical staging and CD4(+) T-cell counts as prognostic tools and to describe survival and cause of death in seroprevalent HIV-1-i nfected Ugandan adults by means of a prospective cohort study. Consecutive HIV-I-infected adults registering with a community HIV/AIDS clinic in Enteb be, Uganda were enrolled between October 1994 to January 1995 and observed during follow-up until the end of December 1997. Baseline CD4(+) T-cell cou nt distribution showed clear and appropriate associations with clinical sta ge in the 201 participants. Both provided equivalent prognostic information : median survival with CD4(+) T-cell count <200 cells/mu l was 9 months (95 % confidence interval [CI], 7-15 months) compared with 19 and 7 months (95% CI, 10-28 and 0-8 months, respectively) in clinical stages 3 and 4, respec tively; survival at 3 years with CD4(+) T-cell count greater than or equal to 200 cells/mu l was 68% and for clinical stage 1 and 2, 80% and 60%, resp ectively. Clinical stage 3 and 4 were 76% sensitive and 65% specific for pr edicting a CD4(+) T-ceI1 count <200 cells/mu l, positive predictive value o f 56%, negative predictive value 78%. In all, 82 participants died (41%; mo rtality rate 216 of 1000 person-years) and was strongly associated with low CD4(+) T-cell counts. In conclusion, clinical staging is valid and compara ble with staging by CD4(+) T-cell counts for epidemiologic measurements. Mo rtality with early disease in Entebbe appears equivalent to that found in t he developed world but there is poor survival with advanced disease.