A Prospective Study of Human Immunodeficiency Virus Type 1 Infection and the Development of AIDS in Subjects with Hemophilia

Viral Epidemiology Section, National Cancer Institute, Bethesda, MD 20892.
New England Journal of Medicine (Impact Factor: 55.87). 11/1989; 321(17):1141-8. DOI: 10.1056/NEJM198910263211701
Source: PubMed


We evaluated a multicenter cohort of 1219 subjects with hemophilia or related disorders prospectively, focusing on 319 subjects with documented dates of seroconversion to human immunodeficiency virus type 1 (HIV-1). The incidence rate of the acquired immunodeficiency syndrome (AIDS) after seroconversion was 2.67 per 100 person-years and was directly related to age (from 0.83 in persons 1 to 11 years old up to 5.66 in persons 35 to 70 years old; Ptrend = 0.00003). The annual incidence of AIDS ranged from zero during the first year after seroconversion to 7 percent during the eighth year, with eight-year cumulative rates (+/- SE) of 13.3 +/- 5.3 percent for ages 1 to 17, 26.8 +/- 6.4 percent for ages 18 to 34, and 43.7 +/- 16.4 percent for ages 35 to 70. Serial immunologic and virologic markers (total numbers of CD4 lymphocytes, presence of serum interferon or HIV-1 p24 antigen, and low or absent serum levels of anti-p24 or anti-gp120) predicted a high risk for the subsequent development of AIDS. Adults 35 to 70 years old had a higher incidence of low CD4 counts than younger subjects (P less than or equal to 0.005), whereas adolescents had a low rate of anti-p24 loss (P = 0.0007) and subjects 1 to 17 years old had a lower incidence of AIDS after loss of anti-p24 (P = 0.03). These findings not only demonstrate that the risk of AIDS is related directly to age but also suggest that older adults are disproportionately affected during the earlier phases of HIV disease, that adolescents may have a low replication rate of HIV, and that children and adolescents may tolerate severe immunodeficiency better because they have fewer other infections or because of some unmeasured, age-dependent cofactor or immune alteration in the later phase of HIV disease.

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Available from: James Drummond, Jul 03, 2014
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    • "Estimating the progression from HIV infection to fullblown AIDS is of particular importance for patient counselling, for deciding if and when to administer treatment, for monitoring the success of therapy, and for health planning (Chiarotti, 1994). Estimates of progression to AIDS among haemophiliacs have recently been produced both in Italy and in other countries based on data from national or multinational cohort studies (Goedert et al., 1989; Darby, 1990). Chiarotti et al. (1992) has presented and discussed the effects of some parametric estimation procedures of seroconversion time on the analysis of progression to AIDS, using data for Italian haemophiliacs. "
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    • "Based on these in vitro findings, we next tested for ex vivo functional differences between dendritic cells from carriers of HLA-B*3503 (Px) or -B*3501 (PY). For this purpose , we conducted MLRs with dendritic cells isolated from the peripheral blood of HAART-naive HIV-1–infected carriers of HLA-B*3503 or -B*3501 recruited from a multicenter cohort of hemophiliac seroconverters (Goedert et al., 1989). HIV-1 viral loads (mean of 52,335 vs. 115,535 copies/ ml, P = 0.39) and CD4 cell counts (mean of 21 vs. 15%, P = 0.23) did not differ significantly between carriers of HLA- B*3501 (PY) and -B*3503 (Px), despite a longer duration of HIV-1 infection in the HLA-B*3501 (PY) group (mean of 13 vs. 10 yr). "
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