Survival with the Acquired Immunodeficiency Syndrome

Abstract

In a cohort of 5833 subjects in whom the acquired immunodeficiency syndrome (AIDS) was diagnosed in New York City before 1986, the cumulative probability of survival (mean +/- SE) was 48.8 +/- 0.7 percent at one year and 15.2 +/- 1.8 percent at five years. The group with the most favorable survival rate--white homosexual men 30 to 34 years old who presented with Kaposi's sarcoma only--had a one-year cumulative probability of survival of 80.5 percent; that group was used as the reference group in assessing the effect of five variables: sex, race or ethnic background, age, probable route of acquiring AIDS (risk group), and manifestations of AIDS at diagnosis. The range in the mortality rate was greater than threefold, depending on these variables. Black women who acquired the disease through intravenous drug abuse, for example, had a particularly poor prognosis. The manifestations of disease at diagnosis had the most influence on survival, accounting on average for 56.3 percent of the excess risk. This variable was followed in importance by age (12.2 percent), race or ethnicity (10.6 percent), risk group (8.4 percent), and sex (8.0 percent), with 4.5 percent of the risk attributable to interactions between variables. When we compared subcohorts based on the year of diagnosis (1981 through 1985), we found a significant improvement in the one-year cumulative probability of survival among subjects with Pneumocystis carinii pneumonia, but not among subjects without P. carinii pneumonia.

HLA-Associated Susceptibility to Acquired Immune Deficiency Syndrome in HIV-1-Seropositive Subjects

“…Out-migration of pa tients from the New York cohort was pro posed as a possible explanation for differ ent survival between the San Francisco and New York cohorts [Bacchetti et al, 1988]. In addition, a more favourable sur vival rate for homosexual men over 30 years of age was observed in New York City [Rothenberg et al, 1987], However, the analyses performed on these two groups of individuals (AIDS pa tients and lost subjects) assessed concording results. In each analysis, B8 or DR3, or B8DR3 or Al B8DR3, was associated with AIDS occurrence, lost status or a particu larly rapid rate of decline of CD4 lympho cyte count.…”

Kaposi's sarcoma of the bone marrow presenting with fever of unknown origin

“…Bone marrow involvement is rare and has been reported in only three instances. Two of these represent clinical reports [4,5] and one was noted in a large review of bone marrow specimens in patients with AIDS [6]. We report KS in a patient with AIDS that was diagnosed by bone marrow biopsy in the absence of known skin or visceral involvement.…”

“…Involvement of the bone marrow by KS appears to be rare. Of the four recent reviews of bone marrow findings in patients with AIDS, only one instance of involvement was reported of the total of 539 specimens examined [5,6,14,15]. Interestingly, in that case the diagnosis of KS was already established before the bone marrow evaluation.…”

AIDS epidemiology: inconsistencies with human immunodeficiency virus and with infectious disease.

“…On average 10-11 years after infection and appearance of neutralizing antibodies, HIV is postulated to cause immunodeficiency by killing billions of T cells (16)(17)(18)(19)(20)(21). Only then, indicator diseases are said to develop from which patients die on average within 1 year (21)(22)(23)(24)(25)(26). Thus HIV became the first virus for which a positive antibody test is interpreted as an indicator for primary diseases that have yet to come.…”