Prognostic factors for all-cause mortality among hemophiliacs infected with human immunodeficiency virus

To identify the prognostic significance of hemophilia- and virus-related factors, the authors undertook a survival analysis among 644 human immunodeficiency virus (HIV)-infected subjects enrolled in the Multicenter Hemophilia Cohort Study between 1985 and 1993. Acquired immunodeficiency syndrome (AIDS) was the leading cause of death, followed by hemorrhage and hepatic disease. Adverse prognostic factors included older age and CD4-positive lymphocyte values below 14 percent either at entry (age-adjusted mortality rate ratio (RR) = 6.4, 95% confidence interval (CI) 3.4-12.1) or after entry (time-dependent RR = 4.2, 95% CI 2.6-6.7); indeterminate antibody responses to hepatitis C virus (RR = 3.0, 95% CI 1.8-5.0); and inhibitory antibodies to factor VIII concentrates (RR = 1.8, 95% CI 1.1-3.1). Indeterminate hepatitis C virus status was associated with mortality from hepatic disease but not with AIDS mortality. Factors that were not prognostic included duration of HIV infection, hepatitis B virus infection, and other hemophilia variables. These findings suggest that fatal liver disease among coinfected subjects with an indeterminate hepatitis C virus status is probably related to an insufficient humoral response secondary to HIV immune dysfunction and that the risk of death among HIV-infected subjects is best evaluated with age and duration of low CD4 percentage.

Predictors of HIV disease progression in women

A retrospective cohort study was conducted to analyze variables predictive of acquired immunodeficiency syndrome (AIDS), as defined by the Centers for Disease Control (CDC) in 1987, and death in 224 women infected with the human immunodeficiency virus (HIV) who were evaluated through two HIV outpatient programs in New Orleans between January 1987 and December 1991 and followed through February 1993. Variables predictive of AIDS in a multivariate proportional hazards model were an entry CD4 cell count < 200/mm3 (adjusted RR 8.2, 95% CI 3.2, 20.9) and rapid CD4 cell count decline (adjusted RR 6.0, 95% CI 2.4, 15.5). A baseline AIDS diagnosis (by the CDC 1987 definition) was highly predictive of death (RR 36.3, 95% CI 15.7, 70.1). In multivariate analyses none of the relative risks for predictive variables remained significant if adjusted for a diagnosis of AIDS at entry. Although immunological parameters were predictive of early HIV disease progression, an AIDS diagnosis was the strongest prognostic indicator of death in a cohort of North American women.

Recurrence of febrile convulsions in a population-based cohort

The risk of recurrence after an initial febrile seizure was 25% in a population-based cohort of 639 children followed from their first febrile seizure. Prognostic factors were an increasing risk of recurrence with younger age at first febrile seizure, a first degree relative with febrile seizures and complex features of the first febrile seizure. The effect of complex features was modified by age at first febrile seizure and family history in that complex features alone did not increase risk of recurrence but further increased the risk for children under 18 months at first seizure and/or with a positive family history. The prognostic factors for all febrile convulsions recurrences were also prognostic for having subsequent complex febrile convulsions. Children with none of the prognostic factors had only a 3% risk of a future complex febrile seizure while children under 18 months at first febrile convulsion and a positive family history or complex features had about a 20% risk of a subsequent complex febrile seizure.