OBJECTIVE: To describe the rate of development of immunodeficiency in human immunodeficiency virus (HIV) infection and to relate this to the risk of death. DESIGN: Inception cohort followed up for up to 12 years from HIV seroconversion until January 1, 1992. SETTING: A regional hemophilia center based in a major teaching hospital. PATIENTS: All 111 patients with hemophilia who seroconverted to HIV-1 between 1979 and 1985 were registered at the center. Patients have been closely followed up clinically and immunologically. OUTCOME MEASURES: Development of immunodeficiency, defined by a CD4 lymphocyte count falling beneath 0.20 and 0.05 x 10(9)/L, and death. RESULTS: Kaplan-Meier estimates suggest that almost half (46%; 95% confidence interval [CI], 26% to 66%) of patients alive 12 years after seroconversion will have a CD4 lymphocyte count that has remained above 0.05 x 10(9)/L. Thirty-five percent (95% CI, 22% to 48%) remain above 0.20 x 10(9)/L. Thirty-seven patients died of HIV-related causes, and there was a 52% probability (95% CI, 35% to 69%) of HIV-related mortality by 12 years from seroconversion. Mortality risk was closely associated with severe immunodeficiency. There was only a 15% chance (95% CI, 6% to 25%) of HIV-related death occurring before a CD4 count of below 0.05 x 10(9)/L had been reached. There was an average of one HIV-related death per 96.7 patient-years of observation before the CD4 count had fallen below 0.05 x 10(9)/L, as compared with one death per 2.5 patient-years of observation after the CD4 count had fallen below this level (P < .0001). CONCLUSIONS: In patients with HIV infection who are closely followed up, the risk of death is low before the CD4 lymphocyte count has fallen to 0.05 x 10(9)/L, a count many patients remain above up to 12 years after seroconversion.
OBJECTIVE: To describe the rate of development of immunodeficiency in human immunodeficiency virus (HIV) infection and to relate this to the risk of death. DESIGN: Inception cohort followed up for up to 12 years from HIV seroconversion until January 1, 1992. SETTING: A regional hemophilia center based in a major teaching hospital. PATIENTS: All 111 patients with hemophilia who seroconverted to HIV-1 between 1979 and 1985 were registered at the center. Patients have been closely followed up clinically and immunologically. OUTCOME MEASURES: Development of immunodeficiency, defined by a CD4 lymphocyte count falling beneath 0.20 and 0.05 x 10(9)/L, and death. RESULTS: Kaplan-Meier estimates suggest that almost half (46%; 95% confidence interval [CI], 26% to 66%) of patients alive 12 years after seroconversion will have a CD4 lymphocyte count that has remained above 0.05 x 10(9)/L. Thirty-five percent (95% CI, 22% to 48%) remain above 0.20 x 10(9)/L. Thirty-seven patients died of HIV-related causes, and there was a 52% probability (95% CI, 35% to 69%) of HIV-related mortality by 12 years from seroconversion. Mortality risk was closely associated with severe immunodeficiency. There was only a 15% chance (95% CI, 6% to 25%) of HIV-related death occurring before a CD4 count of below 0.05 x 10(9)/L had been reached. There was an average of one HIV-related death per 96.7 patient-years of observation before the CD4 count had fallen below 0.05 x 10(9)/L, as compared with one death per 2.5 patient-years of observation after the CD4 count had fallen below this level (P < .0001). CONCLUSIONS: In patients with HIV infection who are closely followed up, the risk of death is low before the CD4 lymphocyte count has fallen to 0.05 x 10(9)/L, a count many patients remain above up to 12 years after seroconversion.
Authors: Rebecca K Lodwick; Caroline A Sabin; Kholoud Porter; Bruno Ledergerber; Ard van Sighem; Alessandro Cozzi-Lepri; Pavel Khaykin; Amanda Mocroft; Lisa Jacobson; Stephane De Wit; Niels Obel; Antonella Castagna; Jan-Christian Wasmuth; John Gill; Marina B Klein; Stephen Gange; Melchor Riera; Cristina Mussini; Félix Gutiérrez; Giota Touloumi; Patrizia Carrieri; Jodie L Guest; Norbert H Brockmeyer; Andrew N Phillips Journal: Lancet Date: 2010-07-15 Impact factor: 79.321
Authors: Amanda Mocroft; Jonathan A C Sterne; Matthias Egger; Margaret May; Sophie Grabar; Hansjakob Furrer; Caroline Sabin; Gerd Fatkenheuer; Amy Justice; Peter Reiss; Antonella d'Arminio Monforte; John Gill; Robert Hogg; Fabrice Bonnet; Mari Kitahata; Schlomo Staszewski; Jordi Casabona; Ross Harris; Michael Saag Journal: Clin Infect Dis Date: 2009-04-15 Impact factor: 9.079
Authors: Enwu Liu; Keming Rou; Jennifer M McGoogan; Lin Pang; Xiaobin Cao; Changhe Wang; Wei Luo; Sheena G Sullivan; Julio S G Montaner; Marc Bulterys; Roger Detels; Zunyou Wu Journal: J Infect Dis Date: 2013-04-16 Impact factor: 5.226
Authors: Guy de Bruyn; Amalia Magaret; Jared M Baeten; Jairam R Lingappa; Patrick Ndase; Connie Celum; Anna Wald Journal: BMC Infect Dis Date: 2012-10-30 Impact factor: 3.090