Low CD4 T Cell Counts before HIV‐1 Seroconversion Do Not Affect Disease Progression in Ethiopian Factory Workers

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Abstract
BackgroundHuman immunodeficiency virus type 1 (HIV-1)–uninfected Ethiopians have lower CD4 T cell counts than do other populations in Africa and industrialized countries. We studied whether this unique immunological profile results in shorter survival times in HIV-1–infected Ethiopians MethodsData from an open cohort study of 149 HIV-1–infected factory workers in Ethiopia for 1997–2002 were used. To estimate survival times, a continuous-time Markov model was designed on the basis of CD4 T cell counts and World Health Organization clinical staging. By use of a random-effects model, decline in CD4 T cell counts was compared between HIV-1–infected Ethiopian and Dutch individuals ResultsMedian survival times were in the range of 9.1–13.7 years, depending on the approach used. This range is similar to that for populations in industrialized countries before the advent of antiretroviral therapy. Ethiopians had a lower annual decline in CD4 T cell counts than did Dutch individuals, which remained when groups with similar CD4 T cell count categories were compared. Moreover, the slower decline in CD4 T cell counts was not due merely to lower HIV-1 RNA loads or an absence of syncytium-inducing/X4 HIV-1 subtype C strains in Ethiopians ConclusionsLow baseline CD4 T cell counts do not imply shorter survival times in Ethiopians than in other populations, presumably because of a slower decline in CD4 T cell counts

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