Natural History of HIV Infection in African Patients

Abstract

To evaluate the natural history and clinical manifestations of human immunodeficiency virus (HIV) infection in Africa a cohort study was conducted of 174 HIV-infected Africans who travelled to Belgium for medical treatment. The study subjects were divided into 4 groups on the basis of their clinical status: stage 1 (26 cases) healthy asymptomatic seropositive patients; stage 2 (45 cases) patients with generalized lymphadenopathy of at least 3 months duration in the absence of any constitutional signs or symptoms; stage 3 (77 cases) subjects with acquired immunodeficiency syndrome (AIDS)-related complex (ARC); and stage 4 (26 cases) full blown AIDS. During the 3-42 month (mean 16 months) study period all of the 26 healthy seropositive patients remained symptom-free. 3 (10%) of the patients with lymphadenopathy and 26 (37%) of ARC patients developed AIDS after a mean evolution period of 33 months and 12 months respectively. The rate of progression from ARC to AIDS documented in this cohort of African patients is similar to that recorded among homosexuals and hemophiliacs in Western countries. Immunologic prognostic markers for evolution from stage 3 to stage 4 included decreased white blood cell count decreased lymphocytosis decreased T4 cells count decreased T4/T8 ratio decreased in vitro lymphocytes response to phytohemagglutinin and increased IgA blood level. Esophageal candidiasis cerebral toxoplasmosis crytococcal meningitis mucocutaneous herpes and extrapulmonary tuberculosis were the most frequent clinical manifestations among stage 3 and stage 4 patients. The natural history and immunological evolution of HIV infection appear to be similar in black and white African patients. The influence of environmental factors on opportunistic infections is suggested by the fact that Pneumocystis carinii pneumonia--the most frequent opportunistic infection among black AIDS patients in the US--is rare among African AIDS patients. 32 (60%) of the patients with AIDS in this study died after a mean time period of 10 months.