Aids in Africa - Survival according to AIDS-defining illness

Objective. Evaluation of prognostic significance of the type of AIDS-defini ng illness (ADI) and performance status in a cohort of AIDS patients. Design, setting, subjects, outcome measures. A retrospective analysis of 28 0 patients with AIDS, as defined by the proposed World Health Organisation (WHO) clinical staging system, who attended two Cape Town-based HIV clinics between 1984 and 1997. Patients were stratified according to the type of i nitial ADI. Survival associated with each opportunistic event was determine d by Kaplan-Meier analysis. Cox proportional hazard analysis was used to de termine relative risk for death associated with three strata of ADI. Results. Median survival associated with various initial ADIs varied from l ess than 3 months (encephalopathy and wasting), to over 2 years (extrapulmo nary tuberculosis and herpes simplex virus infection). This effect of ADI o n outcome was most striking in patients with relatively preserved CD4 count s (CD4 > 50/mul). A performance status score 4 predicted 50% mortality at 1 month, irrespective of co-morbidity, Conclusion. The type of ADI is an important determinant of survival, partic ularly in patients with preserved CD4 counts. The stratification of patient s by type of ADI and performance status may be useful in the management of patients with advanced HIV infection in resource-limited environments.