Mocroft, Amanda J.; (1997) Studies on the prognosis of patients with the acquired immunodeficiency syndrome (AIDS). Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

This thesis presents the epidemiological results of the follow-up of almost nine thousand patients with AIDS diagnosed between 1979 and July 1995 from three groups; the AIDS in Europe Study Group, the Royal Free Hospital cohort and the Chelsea and Westminster Hospital cohort. There is known to be considerable heterogeneity in survival after an AIDS defining diagnosis, such differences may be caused by a variety of factors and it is these factors which are explored in this thesis. AIDS defining events have been ranked in terms of survival. Median survival ranged from 2 to 19 months depending on the diagnosis but the ranking of diseases was consistent after stratification for year of diagnosis, whether the event was an initial or subsequent diagnosis, and whether zidovudine treatment had been initiated. Median survival after an initial AIDS diagnosis in a large group of UK AIDS patients was 20 months, somewhat longer than previously estimated. Patients diagnosed with AIDS after 1987 were significantly more likely to survive their initial AIDS defining event than patients diagnosed before this date. The CD4 lymphocyte count, which drops throughout infection with HIV, and age were found to be strongly related to survival. The median CD4 lymphocyte count at which AIDS defining events occur varied quite widely, similarly, the incidence of AIDS defining events was highly dependent on the CD4 count. Each successive diagnosis of an AIDS defining illness was found to increase the risk of death significantly independently of the latest CD4 lymphocyte count; categorising the events as mild, severe and very severe led to a staging system which also utilised the CD4 lymphocyte count. This staging system was validated on two further cohorts of patients with remarkable agreement. Following the recent identification of a herpes virus thought to play a role in the development of Kaposi's sarcoma, patients who were treated with foscarnet and ganciclovir were found to be at a reduced risk of Kaposi's sarcoma during subsequent follow-up.

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