PROGNOSTIC FACTORS FOR ALL-CAUSE MORTALITY AMONG HEMOPHILIACS INFECTED WITH HUMAN-IMMUNODEFICIENCY-VIRUS

To identify the prognostic significance of hemophilia- and virus-relat ed factors, the authors undertook a survival analysis among 644 human immunodeficiency virus (HIV)-infected subjects enrolled in the Multice nter Hemophilia Cohort Study between 1985 and 1993. Acquired immunodef iciency syndrome (AIDS) was the leading cause of death, followed by he morrhage and hepatic disease. Adverse prognostic factors included olde r age and CD4-positive lymphocyte values below 14 percent either at en try (age-adjusted mortality rate ratio (RR) = 6.4, 95% confidence inte rval (CI) 3.4-12.1) or after entry (time-dependent RR = 4.2, 95% CI 2. 6-6.7); indeterminate antibody responses to hepatitis C virus (RR = 3. 0, 95% CI 1.8-5.0); and inhibitory antibodies to factor VIII concentra tes (RR = 1.8, 95% CI 1.1-3.1), Indeterminate hepatitis C virus status was associated with mortality from hepatic disease but not with AIDS mortality, Factors that were not prognostic included duration of HIV i nfection, hepatitis B virus infection, and other hemophilia variables, These findings suggest that fatal liver disease among coinfected subj ects with an indeterminate hepatitis C virus status is probably relate d to an insufficient humoral response secondary to HIV immune dysfunct ion and that the risk of death among HIV-infected subjects is best eva luated with age and duration of low CD4 percentage.