AEGiS-14IAC: HIV profile from an agricultural estate in Southern Malawi.

14th International AIDS Conference

Barcelona, Spain - July 7-12, 2002

HIV profile from an agricultural estate in Southern Malawi.

Int Conf AIDS 2002 Jul 7-12; 14:(abstract no. C10664)

Jere CS, Hoffman IF, Miller WC, Chimbiya N, Taylor TE, Molyneux ME, Kublin JG
University of Malawi College of Medicine,, Blantyre, Malawi

BACKGROUND: It is estimated that 25-30% of the adult population in urban Malawi is HIV infected. Prevalence rates in rural areas are generally lower than urban areas with the national prevalence rate of about 15%. However, large agricultural estates with many migrant labourers are common in Malawi. These estates may have high rates of HIV transmission.

METHODS: As part of recruitment to study the association between HIV and malaria, voluntary counseling and testing for HIV status was offered to resident employees at a tea estate in southern Malawi. Employees were asked to report to the estate clinic for possible enrollment in a prospective cohort study. For those enrolling, the baseline visit included a CD4 cell count and, in some individuals, an HIV-1 RNA viral load.

RESULTS: The HIV prevalence was 27.7% (656/2366). The prevalence was higher in women [34.2% (307/898)] than in men [23.9% (348/1457)] (p<0.001) and higher in single females [(28.6% (24/84)] than single males [(9.1% (25/275)] (p<0.001). HIV positive persons were slightly older than HIV negative persons (mean: 30.7 vs 29.4, p=0.006). Among 317 enrolled persons, the median CD4 cell count was 364/ é l (interquartile range 252-533). Among 113 persons tested, the median HIV-1 RNA viral load was 111,314 RNA copies/ml (interquartile range 30,405- 237,319). The relationship between CD4 cell count and log HIV-1 RNA was not significant (slope -0.00046, S.E. 0.00037, p=0.211).

CONCLUSIONS: The HIV prevalence in this remote agricultural estate equals the rates in large urban areas. The risk is particularly high for women. A high median CD4 cell count value suggests ongoing transmission events. A high median HIV-1 RNA viral load and failure to detect a relationship between CD4 cell count and viral load may reflect the burden of other intercurrent infections this population is exposed to, and the probability of rapid and malignant HIV disease progression.

Keywords: AEGIS, HIV, HIV Infections, CD4 Lymphocyte Count, Viral Load, Acquired Immunodeficiency Syndrome, Anti-HIV Agents, HIV Seropositivity, Cohort Studies, HIV Antibodies, Prospective Studies, Malawi, Human, Female, Male, Adult, immunology

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C10664