More rapid progression to AIDS in older HIV-infected people: the role of CD4+ T-cell counts.
The tendency for older people with HIV infection to progress more rapidly to AIDS than younger people was studied in a group of 111 anti-HIV-positive haemophiliacs followed for up to 10 years from seroconversion. After 7 years of seropositivity, those aged over 30 years at the time of the first positive anti-HIV test had a cumulative progression rate to AIDS of 50%, compared with only 12% for those aged 10-19 years (Kaplan-Meier estimates). Overall, the relative risk of developing AIDS by any given time after seroconversion was 1.45 for each 10 year increase in age (p = 0.002; 95% confidence limits of 1.15, 1.85; Cox proportional hazards model). After adjustment for the CD4+ T-cell count (median of 10 count measurements per patient, fitted as a time-dependent covariate), the relative risk fell to 1.31 but remained statistically significant (p less than 0.05; 95% confidence limits of 1.03, 1.67). This implies that older people may be at higher risk of progression than their younger counterparts, even if their CD4+ T-cell counts are the same. Hence, prophylaxis against opportunistic infections may be indicated at higher CD4+ T-cell counts in older people than in younger people.
Haemophilia Centre, Royal Free Hospital, London, U.K.
A N
AN
Phillips
C A
CA
Lee
J
J
Elford
A
A
Webster
G
G
Janossy
A
A
Timms
M
M
Bofill
P B
PB
Kernoff
D000163:Acquired Immunodeficiency Syndrome / Q000097:blood / Q000209:etiology / Q000503:physiopathology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000375:Aging; D015496:CD4-Positive T-Lymphocytes / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D015658:HIV Infections / Q000097:blood / Q000209:etiology / Q000503:physiopathology*; D006467:Hemophilia A / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology; D006801:Humans; D007958:Leukocyte Count; D008875:Middle Aged; D016016:Proportional Hazards Models