CLINICAL FACTORS ASSOCIATED WITH PROGRESSION TO AIDS IN THE ITALIAN COHORT OF HIV-POSITIVE HEMOPHILIACS

This study updates estimates of the cumulative incidence of AIDS among Italian patients with congenital coagulation disorders (mostly hemoph iliacs), and elucidates the role of age at seroconversion? type and am ount of replacement therapy, and HBV co-infection in progression. Info rmation was collected both retrospectively and prospectively on 767 HI V-I positive patients enrolled in the on-going national registry of pa tients with congenital coagulation disorders. The seroconversion date was estimated as the median point of each patient's seroconversion int erval, under a Weibull distribution applied to the overall interval. T he independence of factors associated to faster progression was assess ed by multivariate analysis. The cumulative incidence of AIDS was esti mated using the Kaplan-Meier survival analysis at 17.0% (95% CI = 14.1 -19.9%) over an 8-year period for Italian hemophiliacs. Patients with age greater than or equal to 35 pears exhibited the highest cumulative incidence of AIDS over the same time period, 32.5% (95% CI = 22.2-42. 8%). Factor IX recipients (i.e. severe B hemophiliacs) had higher cumu lative incidence of AIDS (23.3% vs 14.2%, p = 0.01) than factor VIII r ecipients (i.e. severe A hemophiliacs)l as aid severe A hemophiliacs o n less-than-20,000 IU/yearly of plasma-derived clotting factor concent rates, as opposed to A hemophiliacs using an average of more than 20,0 00 IU (18.8% vs 10.9%, p = 0.02). No statistically significant differe nce in progression was observed between HBsAg-positive vs HBsAg-negati ve hemophiliacs (10.5% vs 16.4%, p = 0.10). Virological, immunological or both reasons can account for such findings, and should be investig ated from the laboratory standpoint.