9-year HIV-2-associated mortality in an urban community in Bissau, west Africa

Background Community studies with 1-3 years of follow-up have reported four to five times higher mortality in HIV-2-infected than in uninfected adults. In a cohort study of HIV-1, an increasing difference in mortality rates of HIV-1-infected and uninfected individuals is expected over time, because of rising mortality with advancing HIV-1 infection. We therefore investigated long-term survival of HIV-2-infected adults. Methods Adults enrolled in 1987 in a community study of HIV-2 infection in Guinea-Bissau were followed up with serological surveys in 1989 and 1992. Survival was assessed in 1995, 9 years after enrolment. Findings The annual incidence of HIV-2 was 0·7% for adults and tended to be higher for older individuals than for participants aged 15-14 years (relative risk 3·21 [95% CI 0·91-11·37]). With control for age, HIV-2-infected adults had twice as high mortality as uninfected individuals (mortality ratio 2·32 [1·18-4·57]); the mortality ratio was highest in the first year of the study (4·50 [1·31-15·43]). The difference between infected and uninfected individuals was stronger for adults under 45 years of age (mortality ratio 4·72 [1·86-11·97]) than for older people (1·35 [0·51-3·56]). HIV-2-infected individuals living with an infected spouse had significantly higher mortality than HIV-2-infected individuals living with an uninfected spouse (p=0·027). Interpretation HIV-2-associated mortality is not increasing with length of follow-up. Mortality in HIV-2-infected adults is only twice as high as that in uninfected individuals. In the majority of adults, HIV-2 has no effect on survival.