Survival from HIV-1 seroconversion in Southern Africa: a retrospective cohort study in nearly 2000 gold-miners over 10 years of follow-up

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Abstract
To obtain robust estimates of survival with HIV in individuals with known dates of seroconversion in Africa in the pre-antiretroviral era. Mortality rates were estimated in men from four South African gold mines in a retrospective cohort study with 10-year follow-up. HIV testing was carried out with counselling and consent, in random surveys in the early 1990s and in clinics. A total of 1950 HIV-positive men with seroconversion intervals < 3 years were compared with 6164 HIV-negative men with no subsequent evidence of HIV. Unique industry numbers were used to link medical records to demographic and occupational information. Follow-up after leaving the mine was conducted through employment offices across southern Africa, and using South African death registration data. Follow-up was complete for 85% of those who seroconverted. Median survival was 10.5 years overall: 11.5 years for those aged 15-24 at seroconversion, 10.5 years for those aged 25-34, 9.5 years for those aged 35-44, and 6.3 years for those aged 45+ years. The relative mortality rate in comparison with HIV-uninfected miners increased quickly, reaching 13 for those HIV-infected for at least 9 years, and did not vary by age group. Excess mortality increased with age and duration of infection to > 10% per year. Adjusted to age 25-29 years at seroconversion, 5-year survival was 89% and 10-year 62%. This study reports by far the largest cohort of individuals with known dates of seroconversion available in Africa. After adjusting for age, the survival pattern was similar to that seen in the West before antiretroviral therapy was available.