THE INCIDENCE OF HIV-RELATED DISEASE IN A COHORT OF HEMOPHILIC MEN - NATURAL-HISTORY AND CHANGES SINCE THE INTRODUCTION OF PRE-AIDS TREATMENT

One hundred and eleven men with haemophilia at the Royal Free Hospital Haemophilia Centre, London, became infected with HIV between October 1979 and July 1985. This paper describes the incidence of HIV-related disease in this cohort in the absence of pre-AIDS treatment and assess es the effect of antiretroviral and prophylactic therapies on this. In particular the relationship between the CD4 count and the development of HIV-related disease is investigated. Before the introduction of pr e-AIDS treatment in November 1988, 60 patients (54%) had developed som e type of HIV-related pre-AIDS condition or AIDS, a cumulative inciden ce of 77% (95% Confidence Interval 63% to 91%) by nine years after ser oconversion. The probability of developing such conditions was associa ted with falling CD4 lymphocyte counts and an estimated 51% of patient s (95% Confidence Interval 38% to 63%) would be expected to develop so me manifestation of HIV-related disease before their CD4 count has fal len to 0.2 x 10(9)/1. Consequently, only conditions which develop late r in HIV infection (AIDS, oral candida, herpes tester) are likely to b e influenced by treatment. Since November 1988, there has been a reduc tion in these conditions, although the reduction in the rate of new AI DS cases was small (P=0.16). The risk of developing oral candida has b een reduced at low CD4 counts from 12 cases in 76 years of experience below 0.2 x 10(9)/1, prior to November 1988, to two cases in 81 years after November 1988, (P=0.005). Similarly, since that date no herpes t ester infections were observed in our cohort.