Premium
HIV‐disease progression in Swedish haemophiliacs and the influence of replacement therapy
Author(s) -
Astermark J.,
Johnsson H.,
Stigendal L.,
Lethagen S.,
Berntorp E.
Publication year - 1997
Publication title -
haemophilia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.213
H-Index - 92
eISSN - 1365-2516
pISSN - 1351-8216
DOI - 10.1046/j.1365-2516.1997.00122.x
Subject(s) - medicine , haemophilia , seroconversion , clotting factor , incidence (geometry) , arthropathy , disease , antiretroviral therapy , immunology , human immunodeficiency virus (hiv) , pediatrics , viral load , osteoarthritis , pathology , physics , alternative medicine , optics
HIV‐disease progression in terms of the decline in CD4 + cell count, the development of AIDS‐related symptoms and death was studied in 100 Swedish HIV‐positive haemophiliacs and correlated to age and haemophilia treatment. On average 15 years after seroconversion, 66% of the patients had CD4 + cell counts of < 200×10 6 L −1 , 48% had developed AIDS and 56% had died. Age was found to correlate to all three endpoints, also after adjustment for age, annual clotting factor concentrate (CFC) consumption and HIV‐related therapy, i.e. pneumocystis prophylaxis and antiretroviral drugs ( P < 0.05). Total annual CFC consumption showed no significant relationship to the decline in CD4 + cell counts but was inversely correlated to both the development of AIDS‐related symptoms ( P = 0.033) and mortality ( P = 0.014). Prophylactic treatment was not associated with significantly better survival than on‐demand treatment after adjustment for age, CFC consumption and HIV‐therapy. The use of monoclonal‐antibody‐purified CFCs was not found to stabilize the decline in CD4 + cell counts. However, the use of these CFCs was inversely correlated both to the development of AIDS‐related symptoms and to mortality ( P = 0.042 and 0.027, respectively). A similar trend was associated with the use of low‐ and intermediate‐purity CFCs. As compared with the severe haemophilia A subgroup, the moderate haemophilia A patients showed a trend toward slower disease progression, possibly attributable to a lower incidence of haemarthrosis and arthropathy among the latter. We conclude that replacement therapy in HIV‐infected haemophiliacs is important also for HIV‐disease progression, whereas the purity of the CFCs and the regimen used are of minor importance.