Modified Kigali combined staging predicts risk of mortality in HIV-Infected adults in Lusaka, Zambia

作者：Peters Philip J^*; Zulu Isaac; Kancheya Nzali G; Lakhi Shabir; Chomba Elwyn; Vwalika Cheswa; Kim Dhong Jin; Brill Ilene; Meinzen Derr Jareen; Tichacek Amanda; Allen Susan A

来源：AIDS Research and Human Retroviruses, 2008, 24(7): 919-924.

DOI：10.1089/aid.2007.0297

We assessed the utility of the modified Kigali combined (MKC) staging system for predicting survival in HIV-infected Zambian adults in a prospective, longitudinal, open cohort. From 1995 to 2004, HIV-discordant couples (one HIV-infected partner and one HIV-negative partner) were recruited from couples' voluntary counseling and testing centers in Lusaka, Zambia and followed at 3-month intervals. MKC stage, which incorporates clinical stage with erythrocyte sedimentation rate (ESR), hematocrit, and body mass index (BMI), was determined at enrollment. Kaplan-Meier survival and Cox proportional hazard methods were used to calculate median survival and relative hazards. We enrolled 1479 HIV-discordant couples with a combined 7305 personyears of follow-up. Among HIV-infected participants over the 9-year study period, there were 333 confirmed deaths. The time to 50% mortality was 8.5 years with MKC stage 1 and 2 disease compared to 3.7 years with MKC stage 4 disease at enrollment. Survival rates at 3 years were 85% with MKC stage 1 and 2 disease, 74% with MKC stage 3 disease, and 51% with MKC stage 4 disease. A total of 275 HIV- negative partners seroconverted during follow-up. In comparison, survival rates at 3 years were 94% for HIV- negative participants and 92% for participants who seroconverted during follow-up. In multivariate analysis, MKC stage 4 disease (HR = 3.7, 95% CI = 2.7 - 5.0) remained a strong predictor of mortality. Incorporating ESR, hematocrit, and BMI with clinical staging is a powerful, low-cost tool to identify HIV-infected adults at high risk for mortality.

• 出版日期2008-7