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Surviving the strain: HIV mortality rates in the Gambia

What are the chances of surviving AIDS? Do different strains of the HIV virus have different mortality rates? The Medical Research Council, together with the London School of Hygiene and Tropical Medicine, looked at the mortality rates of patients in The Gambia with HIV-1, HIV-2 and of patients with both infections.

Patients in the developed world live on average for another 11 years after contracting HIV-1. However, the other human immuno-deficiency virus, HIV-2, is less well studied. Patients attending the Medical Research Council clinics in Fajara, The Gambia, between May 1986 and September 1997 were recruited to the study. Information was collected from 1 500 patients, aged 15 and over, who were HIV-positive. It was not possible to follow up 11 per cent of patients (161 individuals). These tended to be sex workers, younger, female and less ill.

Patients with HIV-1 or with both infections tended to be at a more advanced stage when they came to the clinic than HIV-2 patients. The study’s finding that individuals in an advanced stage of infection have the same mortality rates suggests that HIV-1 and HIV-2 run the same course once the immune system is severely affected. The good prognosis for patients with early stage HIV-2 suggests that, while some individuals will develop AIDS, many people are not harmed by the infection and can live to a normal and healthy old age.

The study found that:

55 per cent of the patients who took part in the survey died
patients with early-stage HIV-2 had a better chance of survival than HIV-1 patients
HIV-2 patients with advanced disease had the same poor prognosis as HIV-1 patients
patients infected with both strands had mortality rates similar to HIV-1
men with HIV had a higher mortality rate than women. The chances of survival diminished with age.

The report recommends that:

early-stage HIV-2 patients should be informed that they have a better prognosis than HIV-1 patients; they will not necessarily get AIDS; and the risk of transmitting the infection to a baby is much smaller
further research needs to be carried out to discover why the mortality rate among men is higher than amongst women
the Karnofsky index (used to evaluate a patient's progress after therapy) could be used to classify HIV-positive patients at home or at clinic. It was used in the study and is a simple assessment which can be carried out without the need for laboratory facilities.

Source(s):
‘Mortality of HIV-1, HIV-2 and HIV-1/HIV-2 dually infected patients in a clinic-based cohort in The Gambia’, AIDS 16(13): 1775-1783, by Maarten Schim van der Loeff et al, 2002
HINARI subscribers can access the full-text article here. Full document.

Funded by: UK Medical Research Council; Japanese Foundation for AIDS Prevention; Health Sciences Foundation (Japan)

id21 Research Highlight: 22 July 2003

Further Information:
Maarten F. Schim van der Loeff
London School of Hygiene and Tropical Medicine
Keppel Street
London
WC1E 7HT
UK

Contact the contributor: maarten.schim@lshtm.ac.uk

London School of Hygiene and Tropical Medicine, UK

Medical Research Council Laboratoires, Gambia

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