Relationships among the detection of p24 antigen, human immunodeficiency virus (HIV) RNA level, CD4 cell count, and disease progression in HIV-infected individuals with hemophilia

The aim of this study was to assess the relationships among the detection o f p24 antigen, human immunodeficiency virus (HIV) RNA level, CD4 cell count , and disease progression in 111 males with hemophilia who were infected wi th HIV for less than or equal to 20 years. Sixty-four individuals (58%) dev eloped p24 antigenemia a median of 11.6 years after seroconversion. The tim e to first detection of p24 antigen was shorter among those who were older (P=.04) and those with a high initial HIV RNA level (P=.006). The median HI V RNA level and CD4 cell count at the time of the detection of p24 antigen were 4.95log(10) copies/mL and 100 cells/mm(3), respectively. In univariate analyses, p24 antigenemia was associated with more-rapid progression to AI DS (relative hazard [RH], 5.50; P=.0001). The effect was reduced (RH, 1.85; P =.06) after adjusting for CD4 cell counts and HIV RNA levels during foll ow-up, age, and calendar year. A significant relationship between p24 antig enemia and death was nonsignificant after adjusting for CD4 cell count.