HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION IN HEMOPHILIACS IN TAIWAN - THE IMPORTANCE OF CD4 LYMPHOCYTE COUNT IN THE PROGRESSION TO ACQUIRED-IMMUNODEFICIENCY-SYNDROME

From July 1984 to December 1996, we tested and studied 303 haemophilic patients for the infection of the human immunodeficiency virus (HN). Among the 261 haemophilia A patients 44 were HIV positive (16.9%), whi le none of the haemophilia B patients was HIV positive. The mean age o f the 44 HIV-seropositive patients in 1984 was 20.6 years (2-37 years) . Seven who had known seroconversion dates and 29 whose first seroposi tive dates were known seroconverted before 1986. Acquired immunodefici ency syndrome (AIDS) has developed in 16 patients, nine of whom presen ted with Pneumocystis carinii pneumonia, three with tuberculosis infec tion, and 13 had died. The Kaplan-Meier estimate of the progression ra te to AIDS after the date of first seropositive test is about 30% at-t he 10th year. The median survival time after development of AIDS obtai ned from the Kaplan-Meier estimate of the survival curve was 11.7 mont hs. Statistical analysis for the covariate effects on the risk of deve loping AIDS by the Cox proportional hazards model revealed that there was a statistically significant negative association of the risk for p rogression to AIDS with the logarithm of initial CD4 cell counts (P = 0.027) and the rate of decline of CD4 cell counts (P = 0.040), but not with age (P = 0.650). In conclusion, the clinical characteristics of AIDS haemophiliacs in Taiwan were not different from that observed in western countries. Low initial CD4 cell count and sharp decline in CD4 cell counts, but not age, increased the risk of progression to AIDS.