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. 1994 Jul 30;309(6950):309–313. doi: 10.1136/bmj.309.6950.309

Use of CD4 lymphocyte count to predict long-term survival free of AIDS after HIV infection.

A N Phillips 1, C A Sabin 1, J Elford 1, M Bofill 1, G Janossy 1, C A Lee 1
PMCID: PMC2540903  PMID: 7916226

Abstract

OBJECTIVE--To estimate the probability of remaining free of AIDS for up to 25 years after infection with HIV by extrapolation of changes in CD4 lymphocyte count. DESIGN--Cohort study of subjects followed from time of HIV seroconversion until 1 January 1993. Creation of model by using extrapolated linear regression slopes of CD4 count to predict development of AIDS after 1993. SETTING--Regional haemophilia centre in teaching hospital. SUBJECTS--111 men with haemophilia infected with HIV during 1979-85. Median length of follow up 10.1 years, median number of CD4 counts 17. The model was not fitted for three men because only one CD4 measurement was available. MAIN OUTCOME MEASURES--Development of AIDS. INTERVENTIONS--From 1989 prophylaxis against candida and Pneumocystis carinii pneumonia and antiretroviral drugs when CD4 count fell below 200 x 10(6)/l. RESULTS--44 men developed AIDS up to 1 January 1993. When AIDS was defined as a CD4 count of 50 x 10(6)/l the model predicted that 25% (95% confidence interval 16% to 34%) would survive for 20 years after seroconversion and 18% (11% to 25%) for 25 years. Changing the CD4 count at which AIDS was assumed to occur did not alter the results. Younger patients had a higher chance of 20 year survival than older patients (32% (12% to 52%) for those aged < 15, 26% (14% to 38%) for those aged 15-29, and 15% (0% to 31%) for those aged > or = 30). CONCLUSIONS--These results suggest that even with currently available treatment up to a quarter of patients with HIV infection will survive for 20 years after seroconversion without developing AIDS.

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Selected References

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  1. Alcabes P., Muñoz A., Vlahov D., Friedland G. H. Incubation period of human immunodeficiency virus. Epidemiol Rev. 1993;15(2):303–318. doi: 10.1093/oxfordjournals.epirev.a036122. [DOI] [PubMed] [Google Scholar]
  2. Beral V., Peterman T. A., Berkelman R. L., Jaffe H. W. Kaposi's sarcoma among persons with AIDS: a sexually transmitted infection? Lancet. 1990 Jan 20;335(8682):123–128. doi: 10.1016/0140-6736(90)90001-l. [DOI] [PubMed] [Google Scholar]
  3. Biggar R. J. AIDS incubation in 1891 HIV seroconverters from different exposure groups. International Registry of Seroconverters. AIDS. 1990 Nov;4(11):1059–1066. doi: 10.1097/00002030-199011000-00002. [DOI] [PubMed] [Google Scholar]
  4. Bofill M., Janossy G., Lee C. A., MacDonald-Burns D., Phillips A. N., Sabin C., Timms A., Johnson M. A., Kernoff P. B. Laboratory control values for CD4 and CD8 T lymphocytes. Implications for HIV-1 diagnosis. Clin Exp Immunol. 1992 May;88(2):243–252. doi: 10.1111/j.1365-2249.1992.tb03068.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Centers for Disease Control and Prevention (CDC) Projections of the number of persons diagnosed with AIDS and the number of immunosuppressed HIV-infected persons--United States, 1992-1994. MMWR Morb Mortal Wkly Rep. 1993 Jan 15;42(1):17–18. [PubMed] [Google Scholar]
  6. Darby S. C., Rizza C. R., Doll R., Spooner R. J., Stratton I. M., Thakrar B. Incidence of AIDS and excess of mortality associated with HIV in haemophiliacs in the United Kingdom: report on behalf of the directors of haemophilia centres in the United Kingdom. BMJ. 1989 Apr 22;298(6680):1064–1068. doi: 10.1136/bmj.298.6680.1064. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Eyster M. E., Gail M. H., Ballard J. O., Al-Mondhiry H., Goedert J. J. Natural history of human immunodeficiency virus infections in hemophiliacs: effects of T-cell subsets, platelet counts, and age. Ann Intern Med. 1987 Jul;107(1):1–6. doi: 10.7326/0003-4819-107-1-1. [DOI] [PubMed] [Google Scholar]
  8. Fahey J. L., Taylor J. M., Detels R., Hofmann B., Melmed R., Nishanian P., Giorgi J. V. The prognostic value of cellular and serologic markers in infection with human immunodeficiency virus type 1. N Engl J Med. 1990 Jan 18;322(3):166–172. doi: 10.1056/NEJM199001183220305. [DOI] [PubMed] [Google Scholar]
  9. Galai N., Muñoz A., Chen K., Carey V. J., Chmiel J., Zhou S. Y. Tracking of markers and onset of disease among HIV-1 seroconverters. Stat Med. 1993 Nov 30;12(22):2133–2145. doi: 10.1002/sim.4780122207. [DOI] [PubMed] [Google Scholar]
  10. Hendriks J. C., Medley G. F., van Griensven G. J., Coutinho R. A., Heisterkamp S. H., van Druten H. A. The treatment-free incubation period of AIDS in a cohort of homosexual men. AIDS. 1993 Feb;7(2):231–239. doi: 10.1097/00002030-199302000-00012. [DOI] [PubMed] [Google Scholar]
  11. Hughes M. D., Stein D. S., Gundacker H. M., Valentine F. T., Phair J. P., Volberding P. A. Within-subject variation in CD4 lymphocyte count in asymptomatic human immunodeficiency virus infection: implications for patient monitoring. J Infect Dis. 1994 Jan;169(1):28–36. doi: 10.1093/infdis/169.1.28. [DOI] [PubMed] [Google Scholar]
  12. Krämer A., Biggar R. J., Hampl H., Friedman R. M., Fuchs D., Wachter H., Goedert J. J. Immunologic markers of progression to acquired immunodeficiency syndrome are time-dependent and illness-specific. Am J Epidemiol. 1992 Jul 1;136(1):71–80. doi: 10.1093/oxfordjournals.aje.a116422. [DOI] [PubMed] [Google Scholar]
  13. Lane H. C., Masur H., Gelmann E. P., Longo D. L., Steis R. G., Chused T., Whalen G., Edgar L. C., Fauci A. S. Correlation between immunologic function and clinical subpopulations of patients with the acquired immune deficiency syndrome. Am J Med. 1985 Mar;78(3):417–422. doi: 10.1016/0002-9343(85)90332-8. [DOI] [PubMed] [Google Scholar]
  14. Lang W., Perkins H., Anderson R. E., Royce R., Jewell N., Winkelstein W., Jr Patterns of T lymphocyte changes with human immunodeficiency virus infection: from seroconversion to the development of AIDS. J Acquir Immune Defic Syndr. 1989;2(1):63–69. [PubMed] [Google Scholar]
  15. Lee C. A., Phillips A., Elford J., Miller E. J., Bofill M., Griffiths P. D., Kernoff P. B. The natural history of human immunodeficiency virus infection in a haemophilic cohort. Br J Haematol. 1989 Oct;73(2):228–234. doi: 10.1111/j.1365-2141.1989.tb00257.x. [DOI] [PubMed] [Google Scholar]
  16. Lenderking W. R., Gelber R. D., Cotton D. J., Cole B. F., Goldhirsch A., Volberding P. A., Testa M. A. Evaluation of the quality of life associated with zidovudine treatment in asymptomatic human immunodeficiency virus infection. The AIDS Clinical Trials Group. N Engl J Med. 1994 Mar 17;330(11):738–743. doi: 10.1056/NEJM199403173301102. [DOI] [PubMed] [Google Scholar]
  17. Lundgren J. D., Pedersen C., Clumeck N., Gatell J. M., Johnson A. M., Ledergerber B., Vella S., Phillips A., Nielsen J. O. Survival differences in European patients with AIDS, 1979-89. The AIDS in Europe Study Group. BMJ. 1994 Apr 23;308(6936):1068–1073. doi: 10.1136/bmj.308.6936.1068. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Lundgren J. D., Phillips A. N., Pedersen C., Clumeck N., Gatell J. M., Johnson A. M., Ledergerber B., Vella S., Nielsen J. O. Comparison of long-term prognosis of patients with AIDS treated and not treated with zidovudine. AIDS in Europe Study Group. JAMA. 1994 Apr 13;271(14):1088–1092. [PubMed] [Google Scholar]
  19. Masur H., Ognibene F. P., Yarchoan R., Shelhamer J. H., Baird B. F., Travis W., Suffredini A. F., Deyton L., Kovacs J. A., Falloon J. CD4 counts as predictors of opportunistic pneumonias in human immunodeficiency virus (HIV) infection. Ann Intern Med. 1989 Aug 1;111(3):223–231. doi: 10.7326/0003-4819-111-3-223. [DOI] [PubMed] [Google Scholar]
  20. Moss A. R., Bacchetti P., Osmond D., Krampf W., Chaisson R. E., Stites D., Wilber J., Allain J. P., Carlson J. Seropositivity for HIV and the development of AIDS or AIDS related condition: three year follow up of the San Francisco General Hospital cohort. Br Med J (Clin Res Ed) 1988 Mar 12;296(6624):745–750. doi: 10.1136/bmj.296.6624.745. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Phillips A. N., Lee C. A., Elford J., Janossy G., Timms A., Bofill M., Kernoff P. B. Serial CD4 lymphocyte counts and development of AIDS. Lancet. 1991 Feb 16;337(8738):389–392. doi: 10.1016/0140-6736(91)91166-r. [DOI] [PubMed] [Google Scholar]
  22. Phillips A., Lee C. A., Elford J., Janossy G., Bofill M., Timms A., Kernoff P. B. Prediction of progression to AIDS by analysis of CD4 lymphocyte counts in a haemophilic cohort. AIDS. 1989 Nov;3(11):737–741. doi: 10.1097/00002030-198911000-00008. [DOI] [PubMed] [Google Scholar]
  23. Rutherford G. W., Lifson A. R., Hessol N. A., Darrow W. W., O'Malley P. M., Buchbinder S. P., Barnhart J. L., Bodecker T. W., Cannon L., Doll L. S. Course of HIV-I infection in a cohort of homosexual and bisexual men: an 11 year follow up study. BMJ. 1990 Nov 24;301(6762):1183–1188. doi: 10.1136/bmj.301.6762.1183. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Sabin C., Phillips A., Elford J., Griffiths P., Janossay G., Lee C. The progression of HIV disease in a haemophilic cohort followed for 12 years. Br J Haematol. 1993 Feb;83(2):330–333. doi: 10.1111/j.1365-2141.1993.tb08290.x. [DOI] [PubMed] [Google Scholar]
  25. Schechter M. T., Craib K. J., Le T. N., Willoughby B., Douglas B., Sestak P., Montaner J. S., Weaver M. S., Elmslie K. D., O'Shaughnessy M. V. Progression to AIDS and predictors of AIDS in seroprevalent and seroincident cohorts of homosexual men. AIDS. 1989 Jun;3(6):347–353. doi: 10.1097/00002030-198906000-00002. [DOI] [PubMed] [Google Scholar]
  26. Schwartländer B., Horsburgh C. R., Jr, Hamouda O., Skarabis H., Koch M. A. Changes in the spectrum of AIDS-defining conditions and decrease in CD4+ lymphocyte counts at AIDS manifestation in Germany from 1986 to 1991. AIDS. 1992 Apr;6(4):413–420. doi: 10.1097/00002030-199204000-00009. [DOI] [PubMed] [Google Scholar]
  27. Seremetis S. V., Aledort L. M., Bergman G. E., Bona R., Bray G., Brettler D., Eyster M. E., Kessler C., Lau T. S., Lusher J. Three-year randomised study of high-purity or intermediate-purity factor VIII concentrates in symptom-free HIV-seropositive haemophiliacs: effects on immune status. Lancet. 1993 Sep 18;342(8873):700–703. doi: 10.1016/0140-6736(93)91706-r. [DOI] [PubMed] [Google Scholar]
  28. Stein D. S., Korvick J. A., Vermund S. H. CD4+ lymphocyte cell enumeration for prediction of clinical course of human immunodeficiency virus disease: a review. J Infect Dis. 1992 Feb;165(2):352–363. doi: 10.1093/infdis/165.2.352. [DOI] [PubMed] [Google Scholar]
  29. Stevens D. L., Tanner M. H., Winship J., Swarts R., Ries K. M., Schlievert P. M., Kaplan E. Severe group A streptococcal infections associated with a toxic shock-like syndrome and scarlet fever toxin A. N Engl J Med. 1989 Jul 6;321(1):1–7. doi: 10.1056/NEJM198907063210101. [DOI] [PubMed] [Google Scholar]

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