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Objectives:

To determine the rate of CD4 decline and the incidence of opportunistic infections (OIs) among antiretroviral therapy-naive South African HIV-infected patients and inform timing of OI prophylaxis.

Methods:

We used mixed-effect models to estimate CD4 cell decline by CD4 cell count strata in HIV-infected patients in the Cape Town AIDS Cohort between 1984 and 2000. Stratum-specific OI incidence per 100 person-years of observation was determined using incidence density analysis.

Results:

Nine hundred seventy-four patients with 2 or more CD4 cell counts were included. CD4 counts declined by 47.1 cells/μL per year in the stratum with more than 500 cells/μL stratum, 30.6 cells/μL per year in the stratum with 351 to 500 cells/μL, and 20.5 cells/μL per year in the stratum with 201 to 350 cells/μL. Tuberculosis and oral candidiasis were the only OIs that occurred frequently in the stratum with more than 200 …