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HIV-disease progression in Swedish haemophiliacs and the influence of replacement therapy
J Astermark1, H Johnsson1, L Stigendal1
1Department for Coagulation Disorders, University of Lund, University Hospital, Malmö, Sweden,Department of Internal Medicine, Karolinska Hospital, Stockholm, Sweden,Department of Internal Medicine, Sahlgrenska Hospital, Gothenburg, Sweden.
Insights
Clotting factor concentrate replacement therapy is crucial for managing HIV disease progression in hemophiliacs. Higher factor concentrate consumption correlated with reduced AIDS symptoms and mortality, though CFC purity and treatment regimen showed minor impact.
Area of Science:
- Hematology
- Virology
- Immunology
Background:
- HIV infection in hemophiliacs presents unique challenges for disease management.
- Understanding factors influencing HIV disease progression is critical for patient outcomes.
Purpose of the Study:
- To investigate the correlation between hemophilia treatment, specifically clotting factor concentrate (CFC) consumption and purity, and HIV disease progression.
- To assess the impact of age and HIV-related therapies on disease progression endpoints.
Main Methods:
- Retrospective study of 100 Swedish HIV-positive hemophiliacs.
- Analysis of CD4(+) cell count decline, AIDS-related symptoms, and mortality.
- Correlation with age, annual CFC consumption, CFC purity, and HIV-related therapies (prophylaxis, antiretrovirals).
Main Results:
- Age correlated significantly with all disease progression endpoints.
- Higher total annual CFC consumption showed an inverse correlation with AIDS development and mortality.
- Use of monoclonal-antibody-purified CFCs was inversely correlated with AIDS symptoms and mortality.
- Moderate hemophilia A patients showed a trend toward slower progression compared to severe hemophilia A.
Conclusions:
- CFC replacement therapy plays a significant role in managing HIV disease progression in hemophiliacs.
- While CFC purity and treatment regimen appear less critical, higher CFC consumption is linked to better outcomes.
- Age remains a significant factor influencing HIV disease progression in this cohort.
Abstract:
HIV-disease progression in terms of the decline in CD4(+) cell count, the development of AIDS-related symptoms and death was studied in 100 Swedish HIV-positive haemophiliacs and correlated to age and haemophilia treatment. On average 15 years after seroconversion, 66% of the patients had CD4(+) cell counts of < 200×10(6) L(-1) , 48% had developed AIDS and 56% had died. Age was found to correlate to all three endpoints, also after adjustment for age, annual clotting factor concentrate (CFC) consumption and HIV-related therapy, i.e. pneumocystis prophylaxis and antiretroviral drugs (P < 0.05). Total annual CFC consumption showed no significant relationship to the decline in CD4(+) cell counts but was inversely correlated to both the development of AIDS-related symptoms (P = 0.033) and mortality (P = 0.014). Prophylactic treatment was not associated with significantly better survival than on-demand treatment after adjustment for age, CFC consumption and HIV-therapy. The use of monoclonal-antibody-purified CFCs was not found to stabilize the decline in CD4(+) cell counts. However, the use of these CFCs was inversely correlated both to the development of AIDS-related symptoms and to mortality (P = 0.042 and 0.027, respectively). A similar trend was associated with the use of low- and intermediate-purity CFCs. As compared with the severe haemophilia A subgroup, the moderate haemophilia A patients showed a trend toward slower disease progression, possibly attributable to a lower incidence of haemarthrosis and arthropathy among the latter. We conclude that replacement therapy in HIV-infected haemophiliacs is important also for HIV-disease progression, whereas the purity of the CFCs and the regimen used are of minor importance.
