PROGRESSION OF HIV - FOLLOW-UP OF EDINBURGH INJECTING DRUG-USERS WITHNARROW SEROCONVERSION INTERVALS IN 1983-1985

Objective: To describe progression and survival of individuals infecte d with HIV by injecting drug use in Edinburgh. Design and methods: Fro m 313 HIV-infected patients with retrospectively estimated narrow sero conversion intervals, 260 infected via injecting drug use in the years 1983-1985 were selected for the study group. Main outcome measures: T he effects of gender, age, human leukocyte antigen (HLA) type and zido vudine (ZDV) treatment on progression and survival from seroconversion ; Weibull estimates of the AIDS incubation distribution and the overal l survival distribution; slopes of absolute CD4 lymphocyte loss (on th e square root scale) and loss of CD4 percentage. Results: The cumulati ve progression rates at 10 years were 68% to CDC stage IV and 31% to A IDS with a mortality rate of 25%. Three-year survival rates for AIDS a nd CDC stage IV cases were 25 and 72%, respectively. Gender and age ef fects on progression or overall survival were not found, although thos e aged over 30 years experienced poorer survival from AIDS. A strong H LA (A1,B8,DR3) association with faster progression and poorer survival was found. Median survival was estimated by Weibull distribution to b e 12.6 years; median AIDS-free time was estimated to be 11.6 years. CD 4 cell loss was approximately linear when transformed to the square ro ot scale as was the decline in CD4 percentage. Only HLA effects on slo pes were found: A1,B8,DR3 was significantly associated with faster los s of both absolute CD4 cells and CD4 percentage (P < 0.001) and B27 wa s significantly associated with slower loss of CD4 percentage (P=0.01) . Conclusions: Edinburgh IDU do not seem to progress more rapidly than other cohorts with predominantly different risk activities. Older age was associated with poorer survival from AIDS but no gender effect wa s found for progression or overall survival. The dearest significant a ssociation with AIDS progression, mortality and loss of CD4 cells was the phenotype HLA A1,B8,DR3. In contrast HLA B27 was associated with s lower loss of CD4 cells.