Disease progression and survival following specific AIDS‐defining conditions: a retrospective cohort study of 2048 HIV‐infected persons in London

Objective: To assess the impact of specific AIDS‐defining conditions on survival in HIV‐infected persons, with emphasis on the effect of tuberculosis. Methods: A retrospective cohort analysis of HIV‐infected Africans and non‐Africans attending 11 specialist HIV/AIDS units in London enrolled for a comparison of the natural history of HIV/AIDS in different ethnic groups. Results: A total of 2048 patients were studied of whom 627 (31%) developed 1306 different AIDS indicator diseases. Pneumocystis carinii pneumonia accounted for 159 (25%) of initial AIDS episodes and tuberculosis for 103 (16%). In patients with HIV disease, tuberculosis had the lowest risk [relative risk (RR), 1.11; 95% confidence interval (CI), 0.75–1.63], and high‐grade lymphoma had the highest risk (RR, 20.56; 95% CI, 2.70–156.54) for death. For patients with a prior AIDS‐defining illness, the development of subsequent AIDS indicator diseases such as Pneumocystis carinii pneumonia (RR, 1.18; 95% CI, 0.77–1.83) and tuberculosis (RR, 1.36; 95% CI, 0.76–2.47) had the best survival, and non‐Hodgkin's lymphoma had the worst survival (RR, 9.67; 95% CI, 1.26–74.33). Patients with tuberculosis had a lower incidence of subsequent AIDS‐defining conditions than persons with other initial AIDS diagnoses (rate ratio, 0.47; 95% CI, 0.37–0.59). Conclusions: Considerable variation exists in the relative risk of death following different AIDS‐defining conditions. The development of any subsequent AIDS‐defining condition is associated with an increased risk of death that differs between diseases, and this risk should be considered when evaluating the impact of specific conditions. Like other AIDS‐defining conditions, incident tuberculosis was associated with adverse outcome compared with the absence of an AIDS‐defining event, but we found no evidence of major acceleration of HIV disease attributable to tuberculosis.