Clinical and biological evolution of HIV-1 seroconverters in Abidjan, Cote d'Ivoire, 1997-2000

Objective: To describe the clinical and biologic evolution of HIV-1 infection in Africa. Methods: One hundred four HIV-1-infected individuals were identified prospectively from regular blood donors in Abidjan, Cote d'Ivoire. The date of seroconversion was estimated from results of sequential serologic tests. Biologic and clinical follow-up was performed every 6 months, starting as early as possible after seroconversion. Case management followed national guidelines. Results: The median interval between estimated seroconversion and study inclusion was 9.7 months, and the median window of seroconversion was 2.8 months. At baseline, all but two patients were asymptomatic; the median CD4(+) cell count was 527/mm(3) (interquartile range [IR]. 395-684), and the median plasma HTV RNA level was 4.6 log(10) copies/ml (IR, 3.8-4.9). The median follow-up was 23.9 months, and 95% of the patients received primary prophylaxis with co-trimoxazole for opportunistic infections. Of the patients, I presented with wasting syndrome, 3 developed tuberculosis, and 17 had a Centers for Disease Control and Prevention category B-defining event. The 3-year AIDS-free and symptom-free probabilities were 96.7% (95% confidence interval [CI], 87.0-99.2) and 79.3% (95% CI, 67.5-87.2), respectively. During the first 3 years of follow-up, we observed that the median plasma viral load stabilized at >4 log(10) copies/ml and that the median CD4(+) cell count declined by 20 to 25/mm(3) per year. Conclusion: These African seroconverters were moderately immunosuppressed. The median HIV RNA level was high and varied very little during the first 3 years, and there were few clinical events.