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A study was conducted to define the natural history and disease progression of HIV infection in a developing country.A prospective longitudinal cohort study.Forty-two patients with documented dates of HIV seroconversion were followed in Port-au-Prince, Haiti. Patients were seen at 3 month intervals or when ill. Patients were treated for bacterial, mycobacterial, parasitic, and fungal infections, but antiretroviral therapy was not available. Patients were followed until death or until 1 January 2000; median follow-up was 66 months.By Kaplan–Meier analyses, the median time to symptomatic HIV disease (CDC category B or C) was 3.0 years [95% confidence interval (CI) 2.3–5.0 years]. The median time to AIDS (CDC category C) was 5.2 years (95% CI 4.7–6.5 years), and the median time to death was 7.4 years (95% CI 6.2–10.2 years). Community-acquired infections, including respiratory tract infections, acute diarrhea, and skin infections were common in the pre-AIDS period. AIDS-defining illnesses included tuberculosis, wasting syndrome, cryptosporidiosis, cyclosporiasis, candida esophagitis, toxoplasmosis, and cryptococcal meningitis. Rapid progression to death was associated with anemia at the time of seroconversion hazards ratio (HR) 4.1 (95% CI 1.1–15.0), age greater than 35 years at seroconversion HR 4.4 (95% CI 1.1–16.6), and lymphopenia at seroconversion HR 11.0 (95% CI 2.3–53.0).This report documents rapid disease progression from HIV seroconversion until death among patients living in a developing country. Interventions, including nutritional support and prophylaxis of common community-acquired infections during the pre-AIDS period may slow disease progression and prolong life for HIV-infected individuals in less-developed countries.