INDEPENDENT EPIDEMICS OF HETEROSEXUAL AND HOMOSEXUAL HIV-INFECTION INSOUTH-AFRICA - SURVIVAL DIFFERENCES

Survival with HIV infection is shorter in sub-Saharan Africa than in d eveloped countries. The pattern of HIV transmission in our region has changed from homosexual to heterosexual, with viral subtypes similar t o those in North America/Europe and Central Africa, respectively. We c ompared survival for the two transmission patterns after AIDS, and aft er the first CD4+ lymphocyte counts <200/mu l and <50/mu l, for adults presenting 1988-1993. Antiretroviral therapy was excluded. There were 180 homosexuals (63% White, 56% employed) and 314 heterosexuals (67% Black, 34% employed). Extrapulmonary tuberculosis was the AIDS-definin g diagnosis in 36/90 heterosexuals and 5/58 homosexuals (p < 0.0001). Survival after AIDS was longer in heterosexuals (p = 0.0015), but AIDS occurred earlier as shown by their higher CD4+ count at AIDS onset (m edian 98/mu l vs. 40/mu l; p = 0.036). Survival was similar in the two groups after first CD4+ count <200 mu l and <50/mu l. Race, socioecon omic status and morbidity are markedly different in the two transmissi on groups. AIDS occurs with less severe immune suppression in heterose xuals, with correspondingly longer survival. Survival after defined CD 4+ counts, however, is remarkably similar.