Sabin, Caroline Anne; (1995) The follow-up of a cohort of anti-hiv seropositive haemophiliacs for up to 15 years from seroconversion. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

111 men with haemophilia registered at the Royal Free Hospital Haemophilia Centre became infected with HIV between 1979 and 1985 after treatment with infected blood products. These men have been followed for up to 15 years since HIV seroconversion. This thesis presents an epidemiologic follow-up of this cohort of patients. By the end of 1994, 47 men had developed AIDS and 45 had died, Kaplan-Meier progression rates of 56.5[percent] (9570 confidence interval 39.5-73.6) and 46.9[percent] (9570 confidence interval 35.6-582) by 14 years after seroconversion respectively. Prior to the development of AIDS, 82 of the men had developed at least one more minor condition indicative of their HIV infection. Older individuals and those who seroconverted prior to 1981 and from 1983 onwards appear to have a more rapid progression of disease. The CD4 lymphocyte count, which drops throughout infection, is a strong prognostic marker for disease progression. The rate of CD4 decline, the Immunoglobulin A level and the development of p24 antigenaemia all add some additional prognostic information to that provided by the most recent CD4 count alone. In contrast, the CD8 lymphocyte count simply identifies those individuals with the lowest and most rapidly declining CD4 counts. Whilst the beta-2 microglobulin level appears to provide additional prognostic information to the CD4 count at high CD4 levels, it is of less value at lower counts. The development of a bacterial infection prior to AIDS suggests that a patient's condition is likely to deteriorate, irrespective of their immune status. Despite being the best marker of progression, the CD4 count is, unfortunately, measured imperfectly. This has the effect of reducing the apparent relationship with disease progression and may lead to erroneous conclusions about the value of other covariates in a proportional hazards model.

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