MORTALITY AMONG HIV-POSITIVE MILITARY SERVICE APPLICANTS

点击翻译按钮获取中文摘要

Understanding the natural history of human immunodeficiency virus (HIV) infection and its sequelae is essential for assessing the impact of proposed therapies and for effective counseling of affected individuals. The primary objective of this prospective study is to examine the natural history of HIV infection by identifying total and cause-specific mortality in a large geographically diverse cohort of HIV-antibody positive individuals. The risk of death from suicide in this cohort is of special interest; only anecdotal reports are available on the risk of suicide among persons with asymptomatic HIV infection, although persons with AIDS are known to be at increased risk of suicide. Other study objectives include examining geographic and temporal differences in cause-specific mortality in the study population and contributing data to ongoing studies of statistical modeling of HIV incidence based on seroprevalence information. The study group currently consists of 2419 HIV-antibody positive individuals (predominantly young adult males) who have been identified since October 1985 by the U.S. Department of Defense during routine screening of civilian applicants for military service. A comparison group, matched 3:1 with the seropositive individuals, is selected C from among seronegative applicants excluded from military service due to other unrelated medical conditions. Additional seropositive and seronegative subjects are added to the study group annually. Mortality among study subjects is ascertained using the National Z Death Index which is a central computerized index containing identifying information for each death occurring in the United States since 1979. Cause of death is based on death certificates obtained from state vital statistics offices. Mortality rates for seropositive subjects are compared to those for seronegative applicants and to age-,C/) race- and sex-specific U.S. mortality rates. All sensitive study information is protected by strict confidentiality procedures. Mortality follow-up of the study cohort has been completed through 1987 and is now in progress for 1988. Further follow-up will provide exceptionally valuable data on survival in a seropositive cohort larger than that available elsewhere. This application requests support for an additional five years of mortality follow-up of this unique cohort.