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Time from HIV-1 seroconversion to AIDS and death before widespread use of highly-active antiretroviral therapy: a collaborative re-analysis [1]

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Date: 2000-04-01

Reliable estimates of AIDS incubation period, survival time after HIV-1 seroconversion, and factors that influence them are essential to enable us to understand the natural history of HIV-1 disease and to plan healthcare resources. Follow-up studies of HIV-1-infected individuals whose dates of seroconversion can be estimated with reasonable accuracy have been the major source of information for these estimates to date.

Much has already been learnt about the determinants of HIV-1 disease progression. Age at seroconversion is recognised as a crucial factor, with younger age being predictive of slower progression.1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11 Also, the route through which infection is acquired might affect the rate of disease progression.12, 13, 14 However, differences between cohort studies in their methods and the range of ages at seroconversion and exposure group of their participants have prevented a full understanding of such effects, leading to apparent inconsistencies. Several specific questions remain unanswered. Does age at seroconversion predict HIV-1 disease progression in all exposure categories? Is the effect of age equally strong in the different exposure categories? After controlling for age at seroconversion, does the mode through which infection is acquired affect the rate of disease progression or mortality? Is the effect of age at seroconversion quantitatively similar throughout the whole period after seroconversion?

We report an international collaboration established to bring together data from all seroconverter cohorts in Europe, North America, and Australia. The main objective was to provide accurate estimates based on all available data of the time from HIV-1 seroconversion to AIDS and death for people infected at different ages, in different periods, and in different ways, while controlling for the effects of other factors and accounting for differences in methods where appropriate and possible. We report the analyses done to assess the effect of age at seroconversion and exposure category on HIV-1 progression before the advent of highly-active antiretroviral therapy. Additional information, including details of the methods of data collection and the effects of other covariates, will be given elsewhere.

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[1] Url: https://www.sciencedirect.com/science/article/pii/S0140673600020614#tbl1

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