TY - JOUR
T1 - Predictors of the risk of development of Acquired Immunodeficiency Syndrome within 24 months among gay men seropositive for human immunodeficiency virus type 1
T2 - A report from the multicenter AIDS cohort study
AU - Saah, Alfred J.
AU - Muñoz, Alvaro
AU - Kuo, Victor
AU - Fox, Robin
AU - Kaslow, Richard A.
AU - Phair, John P.
AU - Rinaldo, Charles R.
AU - Detels, Roger
AU - Polk, B. Frank
N1 - Funding Information:
Received for publication April 3, 1991, and in final form November 8, 1991 Abbreviations: AIDS, acquired immunodeficiency syndrome; HIV, human immunodeficiency virus; HIV-1, human immunodeficiency virus type 1. 1The Johns Hopkins University School of Hygiene and Public Health, Baltimore, MD. 2The National Institute of Allergy and Infectious Diseases, Bethesda, MD. 3The Northwestern University School of Medicine and the Howard Brown Memorial Clinic, Evanston, IL. 4 The University of Pittsburgh Graduate School of Public Health and School of Medicine, Pittsburgh, PA 5The University of California, Los Angeles, School of Public Health, Los Angeles, CA. Dr. Polk died on October 11, 1988. Correspondence to Dr. Alfred J. Saah, The Johns Hopkins University School of Hygiene and Public Health, 624 N Broadway, Suite 763, Baltimore, MD 21205. This work was supported by research contracts N01 - AI-72631, N01-AI-72632, N01-AI-72634, N01-AI-72676, and N01-AI-32535 from the National Institute of Allergy and Infectious Diseases, and 5M01 -RR-00722 from the National Institutes of Health. The authors thank Ernest Moore for secretarial assistance.
PY - 1992/5/15
Y1 - 1992/5/15
N2 - The natural history of infection with human immunodeficiency virus type 1 (HIV-1) is characterized by a relentless decline in CD4-positive lymphocytes and the ultimate development of acquired immunodeficiency syndrome (AIDS). However, variables other than the CD4-positive lymphocyte level contribute to the measurement of risk for AIDS and can be used as predictors of AIDS onset. This study was undertaken to identify factors that, independently of the CD4-positive lymphocyte level, would predict the risk of AIDS over 24 months in a cohort of HIV-1 seropositive homosexual men receiving no antiretroviral therapy. Demographic, clinical, and laboratory data from 1, 325 white, HIV-1 seropositive participants in the Multicenter AIDS Cohort Study who have been studied for 4 years were analyzed with univariate and multivariate methods. To control for stage of infection, the baseline percentage of CD4-positive lymphocytes (a known marker of disease progression), and the decline of CD4-positive cells during the first 6 months of observation were used as continuous variables. The variables that were independently associated with an increased risk of developing AIDS were: low baseline CD4 percentage, decline in the CD4 percentage during the first 6 months of follow-up, the presence of serum immunoglobulin A at baseline, decrease in hemoglobin during the first 6 months of follow-up, incident fatigue, and the interaction of decline in the CD4 percentage and incident thrush. While low CD4 percentage and other variables have been previously described as prognostic markers, decline in the CD4 percentage and the interaction of that decline and incident thrush have not previously been described as being of prognostic importance. These variables and the analytic method for estimating prognosis may prove useful for selecting and evaluating antiretroviral therapy, instituting prophylactic measures against certain opportunistic infections, and recruitment into clinical trials. Because study participants received no antiretroviral prophylaxis during the period under analysis, the method could be used to estimate the prognosis for those receiving investigational treatment were they to remain untreated, effectively making any participant in a clinical trial his own untreated control. Am J Epidemiol 1992; 135: 1147-55
AB - The natural history of infection with human immunodeficiency virus type 1 (HIV-1) is characterized by a relentless decline in CD4-positive lymphocytes and the ultimate development of acquired immunodeficiency syndrome (AIDS). However, variables other than the CD4-positive lymphocyte level contribute to the measurement of risk for AIDS and can be used as predictors of AIDS onset. This study was undertaken to identify factors that, independently of the CD4-positive lymphocyte level, would predict the risk of AIDS over 24 months in a cohort of HIV-1 seropositive homosexual men receiving no antiretroviral therapy. Demographic, clinical, and laboratory data from 1, 325 white, HIV-1 seropositive participants in the Multicenter AIDS Cohort Study who have been studied for 4 years were analyzed with univariate and multivariate methods. To control for stage of infection, the baseline percentage of CD4-positive lymphocytes (a known marker of disease progression), and the decline of CD4-positive cells during the first 6 months of observation were used as continuous variables. The variables that were independently associated with an increased risk of developing AIDS were: low baseline CD4 percentage, decline in the CD4 percentage during the first 6 months of follow-up, the presence of serum immunoglobulin A at baseline, decrease in hemoglobin during the first 6 months of follow-up, incident fatigue, and the interaction of decline in the CD4 percentage and incident thrush. While low CD4 percentage and other variables have been previously described as prognostic markers, decline in the CD4 percentage and the interaction of that decline and incident thrush have not previously been described as being of prognostic importance. These variables and the analytic method for estimating prognosis may prove useful for selecting and evaluating antiretroviral therapy, instituting prophylactic measures against certain opportunistic infections, and recruitment into clinical trials. Because study participants received no antiretroviral prophylaxis during the period under analysis, the method could be used to estimate the prognosis for those receiving investigational treatment were they to remain untreated, effectively making any participant in a clinical trial his own untreated control. Am J Epidemiol 1992; 135: 1147-55
KW - Acquired immunodeficiency syndrome
KW - HIV
KW - Helper cells
KW - Homosexuality
KW - T-lymphocytes
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U2 - 10.1093/oxfordjournals.aje.a116215
DO - 10.1093/oxfordjournals.aje.a116215
M3 - Article
C2 - 1352940
AN - SCOPUS:0026685065
SN - 0002-9262
VL - 135
SP - 1147
EP - 1155
JO - American journal of epidemiology
JF - American journal of epidemiology
IS - 10
ER -