16th International AIDS Conference Toronto, Canada - August 13 - 18, 2006

RETROSPECTIVE COHORT STUDY OF SURVIVAL RATES IN A SEROCONVERTER COHORT OF NEARLY 2000 SOUTH AFRICAN GOLD-MINERS OVER 10 YEARS OF FOLLOW-UP

Int Conf AIDS. 2006 Aug 13-18;16 Abstract No. ThAc0204

Glynn J.¹, Sonnenberg P.², Nelson G.³, Bester A.⁴, Shearer S.⁴, Murray J.^5
1 London School of Hygiene and Tropical Medicine, Department of Infectious and Tropical Diseases, London, United Kingdom, ² Health Protection Agency, London, United Kingdom, ³ University of the Witwatersrand, School of Public Health, Johannesburg, South Africa, ⁴ Gold Fields Limited, Johannesburg, South Africa, ⁵ National Institute for Occupational Health, Johannesburg, South Africa

BACKGROUND: Current knowledge of survival from seroconversion of adults with HIV in developing countries is based on only a few hundred individuals. This is essential information for assessing interventions, including ARV impact.

METHODS: Mortality rates were estimated in miners with and without HIV infection in a retrospective cohort study with 10 years follow-up. The study, on four gold mines in Gauteng Province, South Africa, used unique industry numbers to link medical records to demographic and occupational information, including follow-up after leaving the mine, through employment offices. HIV testing was carried out with counselling and consent during random surveys in the early 1990s and in STI clinics.

RESULTS: 1950 HIV positive miners with a seroconversion interval of less than 3 years (<2 years for 86%) were compared with 6171 miners tested in 1991 – 3 with no later evidence of HIV infection. Full follow-up information was available on more than 80%. The mortality rate ratio by time since seroconversion (adjusted for age and period), compared to HIV negative miners, was 2.5 for those infected <2years, 5.3 for 2 – 3 years, 11.3 for 4 – 5 years, 7.9 for 6 – 7 years, and 7.1 for 8 or more years. Median survival of HIV positive miners was 11.1 years overall: 11.5 years for those aged 15 – 24 at seroconversion, 11.2 for those aged 25 – 34, 9.8 for those aged 35 – 44, and 6.9 for those aged 45+ years. The relative mortality rate in HIV positive compared to HIV negative miners did not vary by age group.

CONCLUSIONS: This study is much the largest cohort of individuals with known dates of seroconversion available in Africa, HIV infection sharply increased mortality rates to high levels. Mortality rates in the HIV positive men were slightly higher than those in the West before ARVs, but the median survival is slightly longer than that reported in Uganda.

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2006-08-13
ThAc0204

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