Porter, Kholoud; (1998) The UK register of HIV seroconverters: Estimating the times from HIV seroconversion to the development of AIDs and death and associated factors from a cohort of HIV seroconverters. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Knowledge of the distribution of intervals from HIV infection to the development of AIDS and to death, and the factors affecting these intervals is vital to an understanding of the natural history of HIV infection and for making projections of future numbers of AIDS cases. This distribution may have changed since the beginning of the epidemic due particularly to the introduction of anti-retroviral treatment and prophylaxis for Pneumocystis carinii pneumonia. It is likely to be influenced by new advances in the management of HIV infected individuals in the future. Changes in the incubation period distribution could also occur in the absence of changes in available treatments and treatment uptake, due to the evolving distributions of new viral strains. It is therefore important to monitor whether there are changes in the incubation period distribution and, if so, the extent of those changes and factors associated with them. A number of studies have provided estimates for this period in different population groups. Most have tended to focus on one transmission category, e.g. homosexual men, injecting drug users, or haemophiliacs; are small in size; or are no longer recruiting new subjects. This thesis reports on the design, methods and findings from a register of HIV-infected individuals in the UK in whom the date of seroconversion is known with reasonable precision (seroconverters). Baseline and annual follow up information is collected and includes: sex, age, ethnic group, route of HIV transmission, latest CD4 count, details of therapy and prophylaxis, AIDS defining events and vital status. Findings presented in this work are on 2022 seroconverters reported by the end of September 1997, the first 3 years of the Register. Careful documentation of the time that each seroconverter came under unbiased follow up for the purposes of the Register was made so as to minimise any bias resulting from the preferential inclusion of long-term non-progressors and recent seroconverters. Censoring at the end of June 1995, the estimated median time to AIDS from HIV seroconversion was 9.26 years (95% CI=8.46-10.39). Censoring at the end of December 1996 the estimated median time from seroconversion to death (from any cause) was 10.79 years (95% CI= 9.81- 11.36 years). Age was found to be highly associated with disease progression with a relative risk of 1.43 (95% CI= 1.19- 1.71) and 1.51 (95% CI= 1.29- 1.78) for each 10-year increase in age to AIDS and death respectively. After adjustment for the effects of other covariates, no evidence of a difference was found between exposure categories, sex or over calendar time.

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