PROGRESSION OF HIV DISEASE IN A HEMOPHILIC 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. Design - 11 year longitudinal clinical and laboratory study. Setting - A haemophilia centre. Patients - 111 patients infected with HIV during October 1979 to July 1985. Main outcome measures - Symptoms of HIV infection, AIDS, and death. Interventions - 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 < 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 < 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). Conclusion - Treatment seems to be reducing the progression of HIV disease in this haemophilic cohort.