Mortality associated with HIV infection in rural Rakai District, Uganda

Objective: To assess mortality impact of HIV in rural Uganda. Methods: An open cohort of 19 983 adults aged 15-59 years, in Rakai distric t was followed at 10 month intervals for four surveys. Sociodemographic cha racteristics and symptomatology/disease conditions were assessed by intervi ew. Deaths among residents and out-migrants were identified household censu s. Mortality rates were computed per 1000 person years (py) and the rate ra tio (RR) of death in HIV-positive/HIV-negative subjects, and the population attributable fraction (PAF) of death were estimated according to sociodemo graphic characteristics. Mortality associated with potential AIDS defining symptoms and signs was assessed. Results: HIV prevalence was 16.1%. Mortality was 132.6 per 1000 py in HIV-i nfected versus 6.7 per 1000 py in uninfected subjects, and 73.5% of adult d eaths were attributable to HIV infection. Mortality increased with age, but the highest attributable risk of HIV associated deaths were observed in pe rsons aged 20-39 years (PAF > 80%) and in women. HIV associated mortality w as highest in the better educated (PAF greater than or equal to 75%) and am ong government employees (PAF greater than or equal to 82%). Of the HIV-pos itive subjects 40.5% reported no illness < 10 months preceding death, sympt oms were poor predictors of death (sensitivity 1.6-38.8%), and only 9.1% me t the World Health Organization clinical definition of AIDS. Infant mortali ty rates in babies of HIV-infected and uninfected mothers were 209.4 and 97 .7 per 1000, respectively. Conclusion: HIV is taking substantial toll in this population, particularly among the younger better educated adults, and infants. Symptomatology or t he World Health Organization definition of AIDS are poor predictors of deat h. (C) 2000 Lippincott Williams & Wilkins.