Two decades of HIV infection in a cohort of haemophilic individuals: clinical outcomes and response to highly active antiretroviral therapy

Objectives: Many haemophilic individuals infected with HIV died before rece iving antiretroviral therapy (ART). Most who remain alive are chronically i nfected with hepatitis C virus (HCV), which has implications for their prog nosis and choice of ART. The clinical status of a cohort of HIV-positive ha emophilic men is reported together with their response to highly active ant iretroviral therapy (HAART). Design: Longitudinal cohort study. Setting: A comprehensive care haemophilia centre. Patients: A group of 111 haemophilic men who seroconverted to HIV in the pe riod 1979 to 1985. Results: The cohort has been followed since 1979. By 30 April 1999, 57 of t he 111 men had developed AIDS and 65 had died: Kaplan-Meier rates of 57.0% [95% confidence interval (Cl) 46.9-67.0) and 65.1% (95% Cl 52.7-77.4) by 19 .5 years, respectively. AIDS rates have declined since 1997 but death rates have remained high, largely owing to deaths from non-HIV-related causes. T hirty-five patients remain alive and under follow-up at the clinic. The 28 men who had received ART had lower CD4 cell counts than the seven patients who had not received ART, but the two groups were otherwise similar. In tot al, 21 patients are known to have started HAART while under care at the cen tre. By 10-12 months after starting HAART, viral loads dropped by 2.06 log( 10) copies/ml and CD4 cell counts increased by 60 x 10(6) cells/l. In 10 ou t of 18 patients with viral loads initially > 400 copies/ml, a viral load b elow this level was attained; four had changed therapy at the time. Conclusions: While the decision to initiate HAART in haemophilic men should be made carefully because of the possible adverse events, our results sugg est that a good response rate was achieved in this group of men. (C) 2000 L ippincott Williams & Wilkins.