Progression of HIV disease in a haemophilic cohort followed for 11 years and the effect of treatment.
OBJECTIVE
To describe the progression of HIV disease in a haemophilic cohort and to show the influence of treatment.


METHODS
11 year longitudinal clinical and laboratory study.


METHODS
A haemophilia centre.


METHODS
111 patients infected with HIV during October 1979 to July 1985.


METHODS
Symptoms of HIV infection, AIDs, and death.


METHODS
26 asymptomatic patients started taking zidovudine or placebo (1000 mg/day) during November 1988 to February 1990; 10 patients with CD4+ counts of 0.2 x 10(9)/l started zidovudine 500 mg/day during January to November 1990. 35 patients used pentamidine for primary or secondary prophylaxis.


RESULTS
At 11 years from seroconversion the estimated rate of progression to AIDS was 42% (95% confidence interval 27% to 57%); to symptoms 85% (75% to 95%); and to death 41% (25% to 57%). Progression to AIDS was significantly faster in patients aged 25 and over than in those aged less than 25 (relative risk 5.0 (2.4 to 10.4); p less than 0.00001) and in those with previous cytomegalovirus infection than in those not infected (relative risk 3.0 (1.4 to 6.8); p = 0.006). 16 of 27 (59%) patients with p24 antigenaemia developed AIDS compared with 17 of 84 (20%) patients without p24 antigen (p less than 0.001). The risk of progression to AIDS before 30 November 1988 in patients with CD4+ counts less than or equal to 0.2 x 10(9)/l was higher than after November 1988 (relative risk 1.9 (0.85 to 4.43); p = 0.1). For 1989 and 1990 the observed cumulative numbers of AIDS cases (among 81 patients with sufficient CD4+ counts) were 22 and 25 compared with 29 and 37 predicted from the rate of fall of CD4+ counts up to the end of 1988 (p = 0.03).


CONCLUSIONS
Treatment seems to be reducing the progression of HIV disease in this haemophilic cohort.
Lee
C A
CA
Academic Department of Haematology, Royal Free Hampstead.
Phillips
A N
AN
Elford
J
J
Janossy
G
G
Griffiths
P
P
Kernoff
P
P
D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology / Q000503:physiopathology; D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D006679:HIV Seropositivity / Q000188:drug therapy*; D006467:Hemophilia A / Q000150:complications*; D006801:Humans; D007958:Leukocyte Count; D008131:London / Q000453:epidemiology; D008137:Longitudinal Studies; D008214:Lymphocytes; D008875:Middle Aged; D012307:Risk Factors; D016896:Treatment Outcome; D015215:Zidovudine / Q000627:therapeutic use*
D015215:Zidovudine