Validation of the proposed World Health Organization staging system for HIV disease and infection in a cohort of intravenous drug users

R. Bruce Aylward, David Vlahov, Alvaro Muñoz, Elisabetta Rapiti

Research output: Contribution to journalArticle

Abstract

Objective: To assess the prognostic utility of the clinical criteria of the World Health Organization's (WHO) proposed staging system for HIV disease and infection in a cohort of intravenous drug users (IVDU) from the ALIVE study. Methods: All study subjects known to be HIV-seropositive were included in this analysis. Subjects were classified as WHO clinical stage 1, 2, or 3 at their initial seropositive evaluation. Product-limit estimates and Cox proportional hazard models were used to compare time of progression to AIDS (stage 4) for the first three clinical stages. Results: Of the original cohort of 2921 IVDU in the ALIVE study, 694 were known to be HIV-positive by January 1992. At the time of their index visit, 49% of the cohort were WHO clinical stage 1, 10% stage 2 and 41% were stage 3. Demographic characteristics of the three groups were similar. Product-limit estimates for progression to AIDS over a 3-year period were 6.5% (SE, 1.5%), 10.4% (SE, 4.1%) and 17.1% (SE, 2.5%) for clinical stages 1, 2, and 3, respectively (log-rank P=0.003). In a proportional hazards model adjusting for race, age, sex and injection status within 6 months prior to enrollment, the hazard for progression to AIDS was 1.51 [95% confidence interval (CI), 0.60-3.77] and 2.39 (95% CI, 1.40-4.08) for stages 2 and 3, respectively, relative to stage 1. Conclusion: This study, in a population of IVDU, supports the utility of the WHO staging system in predicting progression from HIV seropositivity to AIDS on the basis of clinical signs and symptoms.

Original languageEnglish (US)
Pages (from-to)1129-1133
Number of pages5
JournalAIDS
Volume8
Issue number8
DOIs
StatePublished - Aug 1994

Keywords

  • AIDS
  • HIV
  • Prognosis
  • Staging system
  • Substance use

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases

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