Human Immunodeficiency Virus Type 1 Infection: Relationship of Risk Group and Age to Rate of Progression to AIDS

Abstract

Age differences among risk groups may account for rate differences in progression of human immunodeficiency virus type 1 (HIV-1) infection to AIDS. Institutions in 6 US cities used a common protocol to study infected homosexual blood donors, recipients of blood components, and factor VIII-treated hemophiliacs. Follow-up was every 6 months. Actuarial risk for AIDS 8 years after infection was 51% among blood recipients, 36% among homosexual donors, and 24% among hemophiliacs. Significant risk group differences were explained by age differences among cohorts (medians of 61, 29, and 22 years, respectively). When age was adjusted for and both CD4 cell value and zidovudine treatment were used as time-dependent covariates, homosexual donors had more rapid progression than the other groups. Omitting Kaposi's sarcoma as an AIDS-defining condition removed any significant differences among risk groups except CD4 cell count and age. Thus, major factors in AIDS progression are age-related.

Disease Progression and Survival with Human Immunodeficiency Virus Type 1 Subtype E Infection among Female Sex Workers in Thailand

“…Lymphocyte subpopulations of healthy Thai females are similar to those of whites [33]. A CD4 count !200 cells/mL was added to the CDC AIDS case definition in 1993 [34] and, like other populations [4,35], most Thai patients have !200 CD4 cells/mL when AIDS develops [19,20,36]. In Thailand, opportunistic infections are often diagnosed without laboratory confirmation, and women's medical records were often not available if the women had been treated at a nonstudy facility.…”

Oversight and Monitoring of Blood Safety in the United States

“…These recipients were enrolled into a research protocol along with control recipients of donor units that tested seronegative. The results established the transmission rates of these retroviruses, and identified virological and host factors influencing transmission and clinical outcome of infection [43, 44, 45]. Recent molecular and immunological studies of TSS repository samples from linked ‘infectious clusters’, each composed of an infected donor, one or more infected recipients of that donor’s blood and infected sexual partners of recipients, have yielded a number of fundamental insights into viral quasispecies evolution and HIV disease pathogenesis [46, 47].…”

Mortality rates and causes of death among all HIV-positive individuals with hemophilia in Canada over 21 years of follow-up

“…The disease-attenuating effect of age has been demonstrated previously in a cohort study of HIV-positive subjects who were infected before the widespread use of HAART 25 and is consistent with findings from other studies of individuals with hemophilia and transfusion recipients. [26][27][28][29] In fact, in a meta-analysis of individual patient data from 38 HIV cohort studies, the effect of age on disease progression was noted to be even more pronounced among individuals with hemophilia compared with other exposure categories. 25 The authors hypothesized that the age effect was likely the result of HCV co-infection and liver-related deaths; however, we were unable to show a significant difference in the distribution of deaths by cause (including liver disease) across age categories at the time of seroconversion.…”