AN ASSOCIATION BETWEEN CLOTTING FACTOR CONCENTRATES USE AND MORTALITYIN HUMAN IMMUNODEFICIENCY VIRUS-INFECTED HEMOPHILIC PATIENTS

There is much evidence that clotting factor concentrates (CFC), especi ally the so-called intermediate-purity preparations, exert an immunomo dulating effect in vitro, The impact of this effect on the outcome of human immunodeficiency virus (HIV) infection in hemophiliacs is still controversial. In this retrospective cohort study, the effects of trea tment with CFC on mortality and progression to acquired immunodeficien cy syndrome (AIDS) were estimated while controlling for individual ris k factors. Logistic regression and survival analysis, including the Co x proportional-hazards regression model, were performed with data from a 11-year follow-up of 225 hemophilic patients seropositive for HIV t ype 1 (HIV-1) of two hemophilia centers. Mortality and progression to AIDS rates were strongly associated with lower administration of CFC. After adjusting for age, a statistically significant and robust associ ation was observed. The use of CFC was negatively associated with prog ression to AIDS (P = .0033) and mortality (P = .0033). The adjusted re lative hazards of mortality and progression to AIDS rate between the m ost treated patients (>700 IU/kg/yr) versus the least treated (less th an or equal to 700 IU/kg/yr) were 0.53 (confidence limits, 0.33 to 0.8 6) and 0.57 (0.39 to 0.84), respectively. Although the effects of othe r unmeasured risk factors cannot be excluded with certainty, these res ults suggest that there is a negative association between treatment wi th CFC and progression to AIDS and mortality. (C) 1995 by The American Society of Hematology.