CLINICAL AND IMMUNOLOGICAL FEATURES OF HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION IN PATIENTS FROM BANGKOK, THAILAND

Background To assess the association between the CD4 count and clinica l diseases in a cohort of Thai patients. Methods In all, 1902 patients who presented with human immunodeficiency virus (HIV) infection at th e Chulalongkorn University Hospital in Bangkok were investigated. Resu lts At the time of presentation 295 (15.5%) patients had acquired immu nodeficiency syndrome (AIDS) and there was a highly significant tenden cy for lower CD4 counts in this group (median 67/mm(3)) than in patien ts free of AIDS (median 369/mm(3)). A total of 757 patients had data a vailable on follow-up and were free of AIDS at the first visit. During a median follow-up of 0.9 years, 110 developed AIDS or AIDS-related d eath (12.2/100 person years). Subjects with CD4 count <200/mm(3) at in itial visit showed over a ninefold increase in risk of developing AIDS compared to subjects with levels greater than or equal to 500/mm(3) ( relative risk [RR] = 9.1; 95% CI: 5.4-16.0). The rate/100 person years was 47.1 compared with 6.0 in subjects with levels greater than or eq ual to 500/mm(3). After adjusting for initial CD4 count, homosexual me n showed over a twofold increase in risk of developing AIDS compared t o heterosexuals (RR = 2.4;95% CI : 1.6-4.4) and intravenous drug users (IVDU) showed nearly a twofold increase (RR = 1.8; 95% CI: 0.9-3.9). The increased risk in homosexual men persisted even after further adju stment for clinical stage (RR = 2.2; 95% CI: 1.3-3.7) but the increase d risk in IVDU was attenuated (RR = 1.5; 95% CI: 0.7-3.2) although it remained increased albeit non-significantly. Men tended to progress fa ster to AIDS than women but the difference was not significant. Howeve r, the faster progression in homosexual men was seen even when compare d to heterosexual men only Conclusion The rate of progression to AIDS according to CD4 count group at baseline in this Thai cohort is broadl y comparable with Western cohorts. It appears that heterosexuals in Th ailand show slower progression to AIDS than homosexual men.