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Analysis of clinical AIDS-free interval after CD4+ cell counts fall below 200 x 10(6) L-1 in Japanese haemophiliacs
S Tatsunami1, J Mimaya, T Meguro
1Radioisotope Research Institute, St Marianna University School of Medicine, Kawaski, Japan.
Insights
In Japanese haemophilia patients with HIV-1, the time to AIDS onset after CD4+ counts dropped below 200 cells/µL varied significantly. Higher IgA levels were linked to faster progression to clinical AIDS.
Area of Science:
- Immunology
- Virology
- Hematology
Background:
- Human immunodeficiency virus type 1 (HIV-1) infection in haemophilia patients can lead to acquired immunodeficiency syndrome (AIDS).
- CD4+ T-cell counts are critical indicators of immune system status in HIV-1 infection.
- The 1987 Centers for Disease Control and Prevention (CDC) case definition categorizes AIDS onset.
Purpose of the Study:
- To analyze the time from a CD4+ cell count below 200 x 10(6) L-1 to clinical AIDS onset in Japanese haemophilia patients with HIV-1.
- To identify factors influencing the progression to AIDS in this specific patient cohort.
Main Methods:
- Kaplan-Meier method and proportional hazard models were used for survival analysis.
- Data included 129 Japanese haemophilia patients infected with HIV-1.
- Covariates analyzed were age at time ti (CD4+ < 200 cells/µL), CD4+ and CD8+ cell counts, serum immunoglobulin levels (IgG, IgA, IgM), GOT, GPT, and antiretroviral treatment initiation.
Main Results:
- The 50% AIDS-free interval after CD4+ counts fell below 200 cells/µL was 3.00 years for CDC stage II and 1.71 years for CDC stage III patients (P = 0.0013).
- Higher serum IgA levels at time ti were significantly associated with a shorter time to AIDS onset (P < 0.0001).
- Each 1.0 g L-1 increase in IgA level corresponded to a relative hazard of 1.35 for AIDS onset.
Conclusions:
- There is considerable variability in the time to clinical AIDS onset in Japanese haemophiliacs with HIV-1, even after CD4+ counts drop below 200 cells/µL.
- Serum IgA levels may serve as a prognostic marker for disease progression.
- These findings necessitate individualized therapy and care strategies for HIV-1 infected individuals.
Abstract:
We analysed the time from the date CD4+ cell counts fell below 200 x 10(6) L-1, defined as ti, to the onset of clinical AIDS, according to the 1987 Centers for Disease Control and Prevention case definition, in 129 Japanese haemophilia patients infected with HIV-1. The cumulative onset of clinical AIDS was analysed by the Kaplan-Meier method and proportional hazard model. Incorporated covariates were age of each patient at time ti, as well as CD4+ and CD8+ cell counts, serum levels of IgG, IgA, IgM, GOT and GPT at ti. The time of antiretroviral treatment initiation was also considered. The 50% AIDS-free interval after ti was 3.00 years (95% confidence interval (CI), range 0.49-5.51) and 1.71 years (95% CI, range 0.66-2.76) for the patients at CDC stage II and stage III, respectively (significantly different, P = 0.0013). Among the patients at CDC stage II at ti, higher levels of IgA were tightly associated with a shorter period from ti to onset of clinical AIDS (P < 0.0001), and relative hazard was 1.35 (95% CI, 1.11-1.64) with increase of IgA level by 1.0 g L-1. Thus there is a broad distribution in the time to onset of clinical AIDS in Japanese haemophiliacs even after CD4+ cell counts fall below 200 x 10(6) L-1. This should be taken into consideration in deciding upon the therapy and care of HIV-1 infected people.