Objective - To characterise the natural history of sexually transmitted HIV-I infection in homosexual and bisexual men. Design - Cohort study. Setting - San Francisco municipal sexually transmitted disease clinic. Patients - Cohort included 6705 homosexual and bisexual men originally recruited from 1978 to 1980 for studies of sexually transmitted hepatitis B. This analysis is of 489 cohort members who were either HIV-I seropositive on entry into the cohort (n = 312) or seroconverted during the study period and had ≤24 months between the dates of their last seronegative and first seropositive specimens (n = 177). A subset of 442 of these men was examined in 1988 or 1989 or had been reported to have developed AIDS. Main outcome measures - Development of clinical signs and symptoms of HIV-I infection, including AIDS, AIDS related complex, asymptomatic generalised lymphadenopathy, and no signs or symptoms of infection. Measurements and main results - Of the 422 men examined in 1988 or 1989 or reported as having AIDS, 341 had been infected from 1977 to 1980; 49% (167) of these men had died of AIDS, 10% (34) were alive with AIDS, 19% (65) had AIDS related complex, 3% (10) had asymptomatic generalised lymphadenopathy, and 19% (34) had no clinical signs or symptoms of HIV-I infection. Cumulative risk of AIDS by duration of HIV-I infection was analysed for all 489 men by the Kaplan-Meier method. Of these 489 men, 226 (46%) had been diagnosed as having AIDS. We estimated that 13% of cohort members will have developed AIDS within five years of seroconversion, 51% within 10 years, and 54% within 11.1 years. Conclusion - Our analysis confirming the importance of duration of infection to clinical state and the high risk of AIDS after infection underscores the importance of continuing efforts both to prevent transmission of HIV-I and to develop further treatments to slow or stall the progression of HIV-I infection to AIDS.
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We gratefully acknowledge the cooperation of the many men who participated in this study and the help of our colleagues, including Arthur F Back, Carol Badran, Donald Baker (deceased), Fatmata Bangura, Robert H Byers Jr, Jack Campbell (deceased), David Colbert, Ricardo Cottington, Dean F Echenberg, Joseph G Engelman, Aida Flandez, Donald P Francis, Patty Franklin, Douglas R Franks, Michael A Frigo (deceased), Delia Garcia, Steven Gavin (deceased), Shirley Gee, Stephen C Hadler, Ben Heath, Fred R Ingram, Barbara Kilbourne, Robert Kono, Irene Lee, George F Lemp, Carmen Little, Linda Marquis, Richard W Maus, Bobby Martin, Tim Morta, Janet K A Nicholson, Frank Phillips, Michael Piccini, Rebecca Portugal, Phillip Reiff (deceased), Christopher J Rubino, Charles A Schable, Susan Scheer, Terrence Sha, Jose Sion (deceased), Eric Sorenson, Rand L Stoneburner, Johnny Symons, Ron Underwood, Belinda Van, Eric Vittinghoff, Robert Wade, Stephen H Waterman, Judith Wilber, Thomas E Wilson (deceased) and Laurie Windle. We also thank James W Curran and Stephen B Hulley for reviewing the manuscript and Judith Sedgwick for typing the manuscript. This study was supported by a cooperative agreement (No U62/CCU900 523-03-5) from the Centers for Disease Control, Atlanta, Georgia. Use of trade names is for identification only and does not imply endorsement by the City and County of San Francisco, the Public Health Service, or the United States Department of Health and Human Services.