Spectrum of disease in Africans with AIDS in London

Objective: To compare the spectrum of disease, severity of immune deficiency and chemoprophylaxis prescribed in HIV-infected African and non-African patients in London. Design: Retrospective review of case notes of all HIV-infected Africans and a comparison group of non-Africans attending 11 specialist HIV/AIDS Units in London. Main outcome measures: Comparison of demographic information, first and subsequent AIDS-defining conditions, levels of immune deficiency, and chemoprophylactic practices between the African and non-African groups. Results: A total of 1056 Africans (313 developing AIDS) and 992 non-Africans (314 developing AIDS) were studied. Africans presented later than non-Africans (median CD4+ lymphocyte counts at diagnosis 238 and 371 x 106/l, respectively). Tuberculosis accounted for 27% of initial episodes of AIDS in Africans and 5% in non-Africans; Pneumocystis carinii pneumonia (PCP) was the initial AIDS-defining condition in 34% of non-Africans and 17% of Africans. The incidence of tuberculosis in Africans with another AIDS-indicator disease was 16 per 100 person-years. PCP prophylaxis was prescribed for 40% Africans and 32% non-Africans; only 8% of Africans received tuberculosis preventive therapy. Conclusions: HIV-infected African patients presented at lower levels of CD4+ lymphocyte count, at a more advanced clinical stage, and with different AIDS-indicator diseases as compared with non-Africans. Prophylaxis against tuberculosis should be considered for all HIV-infected African patients in industrialized countries. The high incidence of diseases that are indicative of advanced immunodeficiency (e.g., cytomegalovirus disease) in African patients contrasts with data from Africa, suggesting better survival chances in the UK.