To estimate the rate of progression from
seroconversion to symptomatic disease in adults infected with HIV-1,
and to establish whether the background level of signs and symptoms
commonly associated with HIV-1 in uninfected controls are likely to
affect progression rates.
Longitudinal, prospective cohort study of
people infected with HIV-1 and randomly selected subjects negative for
HIV-1 antibodies identified during population studies.
Study clinic with basic medical care in
275 patients infected with HIV-1
(107 prevalent cases and 168 incident cases) and 246 controls negative
for HIV-1 antibodies.
Main outcome measures
Signs and symptoms of HIV
disease, as determined by stages 2 and 3 of the World Health
Organization clinical staging system.
The median time from seroconversion to
WHO stage 2 was 25.4 months and to stage 3 was 45.5 months. 43% of the
participants infected with HIV-1 had signs or symptoms by two years
after seroconversion. The most common clinical conditions used to
define progression of disease were weight loss, mucocutaneous
manifestations, bacterial infections, chronic fever, and chronic
diarrhoea. Although the rates of these conditions (apart from minor
weight loss) were significantly higher in the participants infected
with HIV-1, they were also relatively frequent in the control group.
Herpes zoster, oral candidiasis, and pulmonary tuberculosis were not
common events in the control group and therefore were more
indicative of infection with HIV-1.
Disease progression associated with
infection with HIV-1 seems to be rapid in rural Uganda. This is most
likely due to the high prevalence of conditions in the general
population that could be taken as symptoms and signs of infection with
What is already known on this topicThe few studies that have reported time from seroconversion to HIV-1
symptomatic disease in poor countries suggest that this interval is
shorter than in rich countriesWhat this study addsProgression from seroconversion to symptomatic disease seems to be
rapid in rural AfricaThe apparent rapid disease progression in rural Africa is most likely
to be due to the high prevalence of what could be taken as symptoms and
signs of HIV-1 in the general population