HIV-disease progression in Swedish haemophiliacs and the influence of replacement therapy.

Abstract

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.