Progression of HIV disease in a haemophilic cohort followed for 11 years and the effect of treatment.

Lee, C A; Phillips, Andrew; Elford, Jonathan; Jánossy, G.; Griffiths, Paul; Kernoff, P. B. A.

doi:10.1136/bmj.303.6810.1093

Cited by 66 publications

(29 citation statements)

References 30 publications

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“…This information has been reported from a number of studies of cohorts of haemophilic patients. In the report by Lee et al (1991), those over the age of 25 years were found to have a relative risk of progression to AIDS of five-fold when compared to those below this age. Darby et al (1990) and Rabkin et al (1993) presented evidence to suggest that disease progression increased in proportion to advancing age.…”

Section: Other Factors In Hiv Disease Progressionmentioning

confidence: 99%

Herpesviruses as Co-Factors of HIV Disease: Case not Proven

Jeffries

1995

Antivir Chem Chemother

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SummaryFactors other than human immunodeficiency virus (HIV) may be important in determining disease progression in AIDS. The concept that viruses may act as co-factors in HIV pathogenesis has been based on in vitro studies of potential molecular or biological interactions between HIV and other viruses, some epidemiological evidence for an adverse effect of cytomegalovirus on progression to AIDS, and the apparent survival advantage conferred by aciclovir prophylaxis in people with AIDS.It is possible that molecular or cellular interaction between herpesviruses or other infectious agents and HIV are necessary to encourage the virus into maximal production or to amplify pre-existing replication. However, there is no evidence as yet that this occurs, and studies that claim to show such an effect cannot be convincing unless they take account of the significant associations of progression with virus phenotype, host response, age and genetic factors. This paper was presented as the case against in a debate on 'Herpesviruses as co-factors of HIV disease'. The case for was made by Paul Griffiths (see page 17).

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Section: Other Factors In Hiv Disease Progressionmentioning

confidence: 99%

Herpesviruses as Co-Factors of HIV Disease: Case not Proven

Jeffries

1995

Antivir Chem Chemother

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“…In reality, many people develop clinically significant symptoms before their CD4 count drops below 200 cells/mm 3 , while others have no symptoms until years after their CD4 count declines below that threshold. 13 Cohort studies of persons infected as adults undertaken in the 1980s and 1990s found that *50% of persons develop symptoms of HIV infection within 7 years of infection, 14 with a quarter to half developing an AIDS-defining illness in the 9-11 years following infection. 14,15 The median time from infection to CD4 count <200 cells/mm 3 in the model is 8 years, roughly corresponding to the median onset of illness in cohort studies.…”

Section: Methodsmentioning

confidence: 99%

Optimizing the Timing of HIV Screening as Part of Routine Medical Care

Golden

Dombrowski

2017

AIDS Patient Care and STDs

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US federal guidelines recommend that medical providers test all adolescents and adults for HIV infection at least once before the age of 64. The wide age range included in these guidelines may limit their utility and impact. We created an arithmetic model to estimate how HIV screening at different ages would impact the total number of years of undiagnosed HIV infection in the population and the number of persons developing clinical manifestations of HIV/ AIDS. Our base case model assumed that age of infection in the screened population was the same as the estimated age of infection among all persons diagnosed with HIV in the United States in 2010. We parameterized a second model assuming age of infection was similar to the younger age distribution observed in African Americans. In the base case model, the number of years of undiagnosed HIV infection and number of persons with clinical manifestations of HIV/AIDS were both minimized by screening at age 34. If age of infection was similar to that estimated to occur among African Americans, testing at age 24 and 27 would minimize the number of years of undiagnosed infection and clinical cases, respectively. For both parameterization scenarios, testing between the ages of 21 and 38 resulted in outcomes within 10% of the model's estimated optimal age for screening. Focusing HIV screening on a narrower age range than is currently recommended may improve the impact of routine HIV screening efforts.

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“…It was suggested to be an independent predictor of CD4 + cell depletion (Muñoz et al 1988). Also, it was found to contribute to a faster development of AIDS in the studies developed by Polk et al (1987) and Lee et al (1991). But no other study that evaluated the variable indicated its prognostic value (Goedert et al 1987, Fernández-Cruz et al 1990, Saah et al 1992.…”

Section: Cofactorsmentioning

confidence: 99%

“…Lee et al (1991), in turn, reported that the effect of cytomegalovirus was independent of age, among hemophiliacs.…”

Section: Cofactorsmentioning

confidence: 99%

“…Lee et al (1991) compared the risk of progression to AIDS, after the CD4 + count had fallen below certain cut off levels (50, 100, 150, and 200 cells/mm 3 ), observed up to and after November 1988, month in which they first treated asymptomatic patients with AZT. They found that, whichever cut off was chosen, there was a higher risk of progression to AIDS before November 1988.…”

Section: Cofactorsmentioning

confidence: 99%

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