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Pre-AIDS Mortality and Its Association with HIV Disease Progression in Hemophilic Men, Injecting Drug Users, and Homosexual Men M. PRINS1*, C. A. SABIN2, C. A. LEE2, H. DEVEREUX2, and R. A. COUTINHO1.
1Municipal Hlth. Service, Amsterdam, The Netherlands; and
2Royal Free and Univ. Coll. Med. Sch., London, UK Objective: To study pre-AIDS mortality and its association with HIV disease progression in different exposure groups with known intervals of HIV seroconversion.
Methods: The type and rate of pre-AIDS deaths were assessed in 111 HIV-infected hemophilic men followed in London, and 118 injecting drug users (IDU) and 158 homosexual men followed in Amsterdam. In each group, the association between CD4+ T-cell count, CD8+ T-cell count, HIV RNA and pre-AIDS mortality was studied using proportional hazards analysis.
Results: By 10 years after seroconversion 7.3% of the hemophilic men were expected to have died without AIDS and 38.2% were expected to have developed AIDS. These figures were 20.2% and 30.5% for IDU, and 8.0% and 55.0% for homosexual men. The major causes of pre-AIDS mortality appear to differ in the three exposure groups: deaths were mainly due to HCV infection in hemophilic men, to overdose/suicide and bacterial infections in IDU, and to cancer and immunosuppression in homosexual men. The risk of pre-AIDS death tended to increase with decreasing CD4 counts and increasing HIV RNA levels in IDU and homosexual men. In men with hemophilia associations were less obvious, although the log transformed CD4 and CD8 cell count were predictive for pre-AIDS death.
Conclusions: Pre-AIDS deaths occur and are at least partially related to HIV disease progression irrespective of how individuals became infected. Because of the longer life expectancy due to HAART, pre-AIDS deaths are likely to further arise. Methods to incorporate these intermediate outcomes should be considered in the estimation of the size of the HIV epidemic and in the survival analysis of HIV infected individuals. Prevention and treatment of non-AIDS infections, especially HCV infection, and cancers will become increasingly important in HIV-infected individuals. The interaction between these therapeutic interventions and HAART should be closely monitored.
Key Words: disease progression, exposure groups, pre-AIDS mortality
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