Clinical Factors Associated with Progression to AIDS in the Italian Cohort of HIV-Positive Hemophiliacs

Abstract

SummaryThis study updates estimates of the cumulative incidence of AIDS among Italian patients with congenital coagulation disorders (mostly hemophiliacs), and elucidates the role of age at seroconversion, type and amount of replacement therapy, and HBV co-infection in progression. Information was collected both retrospectively and prospectively on 767 HIV-1 positive patients enrolled in the on-going national registry of patients with congenital coagulation disorders. The seroconversion date was estimated as the median point of each patient’s seroconversion interval, under a Weibull distribution applied to the overall interval. The independence of factors associated to faster progression was assessed by multivariate analysis. The cumulative incidence of AIDS was estimated using the Kaplan-Meier survival analysis at 17.0% (95% Cl = 14.1-19.9%) over an 8-year period for Italian hemophiliacs. Patients with age greater than or equal to 35 years exhibited the highest cumulative incidence of AIDS over the same time period, 32.5% (95% Cl = 22.2-42.8%). Factor IX recipients (i.e. severe B hemophiliacs) had higher cumulative incidence of AIDS (23.3% vs 14.2%, p = 0.01) than factor VIII recipients (i.e. severe A hemophiliacs), as did severe A hemophiliacs on less-than-20,000 IU/yearly of plasma-derived clotting factor concentrates, as opposed to A hemophiliacs using an average of more than 20,000 IU (18.8% vs 10.9%, p = 0.02). No statistically significant difference in progression was observed between HBsAg-positive vs HBsAg-negative hemophiliacs (10.5% vs 16.4%, p = 0.10). Virological, immunological or both reasons can account for such findings, and should be investigated from the laboratory standpoint.

Morbidity and mortality in ageing HIV‐infected haemophilia patients

“…As expected, the proportion of patients who developed AIDS did not increase since Roosendaal's earlier report on this cohort, while the proportion of deceased patients did [12]. The relatively large proportion of HIV-infected haemophilia B patients who were deceased (78% (95% CI: 40-97%), vs. 47% (33-62%) in haemophilia A patients) could, at first sight, corroborate the more unfavourable prognosis of HIV infection in haemophilia B reported by others [24][25][26]. This is hypothesized to be related to the type of clotting-factor product that was contaminated with the HIV virus (carrying e.g.…”

Clinical outcomes of HIV-HCV co-infection in a large cohort of hemophiliac patients

“…The temporal variability of progression to AIDS in our cohort is etiologically unclear. In other hemophiliac patient cohorts, progression to AIDS was significantly linked to the dosage of clotting factor concentrates received, 13 the age at HIV seroconversion, 14,15 CMV seropositivity prior to HIV acquisition 16 or certain immunogenetic characteristics. 17 In our patient population, we cannot exclude that the variable cumulative time of HCV infection might have substantially impacted the clinical progression to AIDS.…”

The Need for Highly Purified Products to Treat Hemophilia B

“…According to Schinaia et al [3], it is higher than in factor VIII recipients, but according to Goedert et al [4], it is comparable to factor VIII recipients. Well-known potential causes for immunomodulatory effects of clotting factor concentrates are viral contaminants, fibronectin, immune complexes, protein aggregates, and transforming growth factor-Pi.…”