HIV Infection Progresses to AIDS Quicker in Developing Countries

The progression from HIV infection to AIDS and death from AIDS is more rapid in people living in developing countries than those living in the United States and Europe, according to researchers from the Johns Hopkins Bloomberg School of Public Health, the Armed Forces Research Institute of Medical Sciences and Chiang Mai University in Thailand. The researchers tracked the length of time between HIV infection and AIDS among young Thai men. They also studied the death rate of the men 5-7 years after their HIV infection, which was higher when compared to their counterparts in developed countries. The study, “The Natural History of HIV-1 Infection in Young Thai Men After Seroconversion” is published in the May 2004 issue of the Journal of Acquired Immune Deficiency Syndrome.

“The importance of this study is that it demonstrates the survival and progression rates of HIV/AIDS from the time of HIV infection in a developing country and documents that the progression is more rapid than in the U.S. and Europe,” said Kenrad E. Nelson, MD, corresponding author and a professor in the Department of Epidemiology.

The researchers evaluated 235 men, who seroconverted during their two years of military service in the Royal Thai Army from 1991 to 1995. All of the men were drafted at the age of 21. After five to seven years, 156 were alive, 77 had died and 2 could not be located. The five-year survival rate of the study participants was 82 percent.

The median time from HIV-1 seroconversion to clinical AIDS in the Thai study participants was 7.4 years. A 2000 study by the Collaborative Group on AIDS Incubation and HIV Survival, known as CASCADE, which studied over 13,000 persons in whom the time of HIV infection was documented found that the medium time after HIV infection to the development of AIDS for persons in Europe, North America and Australia was 11 years for study participants who were 15-24 years old.

The mortality rate of the Thai men was 56.3 deaths per 1,000 person-years, or 18 percent five years after HIV-1 infection, as compared to a 9 percent mortality rate among individuals living in Western developed countries.

“These data will be very useful as treatment of HIV and opportunistic infections become more available for persons in developing countries. We will be able to measure the treatment’s effect on progression and survival after HIV infection,” said Dr. Nelson, who said that he would like to do a follow-up study on this cohort of men.

The study was supported by Cooperative Agreement DAMD17-98-2-7007 between the U.S. Army Medical Research and Material Command and the Henry M. Jackson Foundation for the Advancement of Military Medicine. Additional support came from the Johns Hopkins University Fogarty AITRP grant.

Chris Beyrer, in the Department of Epidemiology, co-authored the article, in addition to Ram Rangsin, Joseph Chiu, Chirasak Khamboonruang, Narongrid Sirisopana, Sakol Eiumtrakul, Arthur E. Brown, Merlin Robb, Cholticha Roengyutikarn and Lauri E. Markowitz.

Public Affairs media contacts for the Johns Hopkins Bloomberg School of Public Health: Kenna Brigham or Tim Parsons at 410-955-6878 or paffairs@jhsph.edu. Photographs of Kenrad Nelson and Chris Beyrer are available upon request.