An association between clotting factor concentrates use and mortality in human immunodeficiency virus-infected hemophilic patients.
There is much evidence that clotting factor concentrates (CFC), especially the so-called intermediate-purity preparations, exert an immunomodulating effect in vitro. The impact of this effect on the outcome of human immunodeficiency virus (HIV) infection in hemophiliacs is still controversial. In this retrospective cohort study, the effects of treatment with CFC on mortality and progression to acquired immunodeficiency syndrome (AIDS) were estimated while controlling for individual risk factors. Logistic regression and survival analysis, including the Cox proportional-hazards regression model, were performed with data from a 11-year follow-up of 225 hemophilic patients seropositive for HIV type 1 (HIV-1) of two hemophilia centers. Mortality and progression to AIDS rates were strongly associated with lower administration of CFC. After adjusting for age, a statistically significant and robust association was observed. The use of CFC was negatively associated with progression to AIDS (P = .0252) and mortality (P = .0033). The adjusted relative hazards of mortality and progression to AIDS rate between the most treated patients (> 700 IU/kg/yr) versus the least treated (< or = 700 IU/kg/yr) were 0.53 (confidence limits, 0.33 to 0.86) and 0.57 (0.39 to 0.84), respectively. Although the effects of other unmeasured risk factors cannot be excluded with certainty, these results suggest that there is a negative association between treatment with CFC and progression to AIDS and mortality.
Montoro
J B
JB
Hemophilia Centre, Hospital General Universitario Vall d'Hebron, Barcelona, Spain.
Oliveras
J
J
Lorenzo
J I
JI
Tusell
J M
JM
Altisent
C
C
Molina
R
R
Ayestarán
A I
AI
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications / Q000401:mortality; D000293:Adolescent; D000328:Adult; D001779:Blood Coagulation Factors / Q000009:adverse effects* / Q000302:isolation & purification; D001798:Blood Proteins / Q000009:adverse effects; D002648:Child; D015331:Cohort Studies; D015897:Comorbidity; D018450:Disease Progression; D004340:Drug Contamination; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000401:mortality* / Q000635:transmission; D015497:HIV-1; D006467:Hemophilia A / Q000150:complications* / Q000628:therapy; D006801:Humans; D007108:Immune Tolerance; D015993:Life Tables; D016015:Logistic Models; D008297:Male; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013030:Spain / Q000453:epidemiology; D016019:Survival Analysis
D001779:Blood Coagulation Factors; D001798:Blood Proteins