HIV infection in Haiti: natural history and disease progression

Objective: A study was conducted to define the natural history and disease progression of HIV infection in a developing country. Design: A prospective longitudinal cohort study. Methods: Forty-two patients with documented dares of HIV seroconversion wer e followed in Port-au-Prince, Haiti. Patients were seen at 3 month interval s or when ill. Patients were treated for bacterial, mycobacterial, parasiti c, and fungal infections, but antiretroviral therapy was not available. Pat ients were followed until death or until 1 January 2000; median follow-up w as 66 months. Results: By Kaplan-Meier analyses, the median time to symptomatic HIV disea se (CDC category B or C) was 3.0 years [95% confidence interval (CI) 2.3-5. 0 years]. The median time to AIDS (CDC category C) was 5.2 years (95% CI 4. 7-6.5 years), and the median time to death was 7.4 years (95% CI 6.2-10.2 y ears). Community-acquired infections, including respiratory tract infection s, acute diarrhea, and skin infections were common in the pre-AIDS period. AIDS-defining illnesses included tuberculosis, wasting syndrome, cryptospor idiosis, cyclosporiasis, candida esophagitis, toxoplasmosis, and cryptococc al meningitis. Rapid progression to death was associated with anemia at the time of seroconversion hazards ratio (HR) 4.1 (95% CI 1.1-15.0), age great er than 35 years at seroconversion HR 4.4 (95% CI 1.1-16.6), and lymphopeni a at seroconversion HR 11.0 (95% CI 2.3-53.0). Conclusion: This report documents rapid disease progression from HIV seroco nversion until death among patients living in a developing country. Interve ntions, including nutritional support and prophylaxis of common community-a cquired infections during the pre-AIDS period may slow disease progression and prolong life for HIV-infected individuals in less-developed countries, (C) 2000 Lippincott Williams & Wilkins.