Briefly, in the first survey round in 1989–1990, the entire adult population (aged ≥13 years) of 15 neighbouring villages underwent a census and serosurvey. In 1999, 10 villages were added to the survey area. Data collection PD-0332991 mouse includes monthly recording of births and deaths, and annual house-to-house censuses and serosurveys. The Rural Clinical Cohort (RCC) presented here is nested within the GPC, and consists of a random selection of one-third of the HIV-1-seropositive adults

identified from the initial (1989–1990) survey and HIV seroconverters identified during subsequent survey rounds, together with age-stratified HIV-negative controls. Since 2004, ART-eligible GPC participants have been enrolled in the RCC to access ART, but no controls have been enrolled for these cases. Trichostatin A manufacturer RCC participants for whom there is no recorded previous negative HIV test, and for whom the date of seroconversion cannot therefore be estimated, are ‘prevalent cases’, while those for whom a date of

seroconversion can be estimated, as the midpoint of the last negative and first positive HIV tests, are ‘HIV seroconverters’. HIV seroconverters were only invited to enrol in the RCC if the interval between the last negative and first positive HIV tests was less than 4 years. Only seroconverters and HIV-negative controls were included in the present analyses. Prevalent cases were excluded from the current study. Survey staff visited the individuals identified for RCC enrolment and explained the nature of the study. Participants were invited to attend the study clinic, and, after giving written informed consent, were enrolled. They were seen every 3 months for routine appointments, at which a full medical assessment was undertaken, and were staged according to the WHO clinical staging system.

Participants were invited to visit the clinic for the investigation and treatment Cyclic nucleotide phosphodiesterase of medical problems occurring between routine appointments. All medical problems were investigated and free treatment was provided. Patients who required in-patient care were referred to the local hospital. Since 1 January 2004, free ART has been provided to eligible RCC participants, in line with the first edition of the Uganda Ministry of Health ART guidelines [13]. Individuals are eligible for ART if they have a CD4 cell count of ≤200 cells/μL, WHO clinical stage 4 disease, or advanced stage 3 disease with persistent or recurrent oral thrush and invasive bacterial infections, regardless of CD4 count, or if they are pregnant with a CD4 count of ≤250 cells/μL. First-line treatment consists of a combination of zidovudine, lamivudine and nevirapine, with the possibility of switching to stavudine in cases of zidovudine toxicity and to efavirenz in cases of nevirapine toxicity or concurrent tuberculosis. In the present study after ART initiation, participants were seen for follow-up at 2 weeks, 4 weeks and then monthly.