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β2-microglobulin as a predictor of death in HIV‐infected women from Kigali, Rwanda

Objective:To determine if β2-microglobulin (β2M) predicts death among HIV-infected African women.Design:Nested case-control study.Setting:Kigali, Rwanda.Participants:Two hundred and five seroprevalent women known to be HIV-infected since 1986–1987; 67 of whom died of HIV disease (cases) and 138 were alive (controls) as of November 1991. In addition, 128 women who seroconverted between 1986 and 1991.Main outcome measures:HIV serology, clinical signs and symptoms of HIV disease, hematology variables, and β2M concentration.Results:β2M concentration increased over time (P< 0.001) in the seroprevalent women and seroconvertors. The average rate of β2M increase in women who died was 0.5 compared with 0.3 mg/l/year in the vital, seroprevalent women (P=0.07). The strongest independent predictors of death were the rate of change of β2M (mg/l/year) [odds ratio (OR), 3.4; 95% confidence interval (Cl), 1.7–6.8] and baseline β2M concentration (mg/l) [OR, 1.6; 95% Cl, 1.2–2.1]. The rate of death for women with β2M concentration ≥ 7.0 mg/l and a rate of change of β2M ≥0.4 mg/l/year was 7.3 times higher than for women with β2M concentration < 7.0 mg/l and a rate of change of β2M of < 0.4 mg/l/year (95% Cl, 3.1–1 7.2). The estimated median time from seroconversion to death assuming a constant rate of change of β2M was 10.6 years (95% Cl, 9.9–11.2) for this cohort of HIV-infected women.Conclusions:Elevated β2M and a high rate of β2M increase were strongly associated with mortality among HIV-infected African women. Based on survival estimates using the rate of change of β2M, HIV-infected African women have similar survival compared with HIV-infected adults in the United States.