Epidemiology and Infection

Research Article

The effect of CMV infection on progression of human immunodeficiency virus disease in a cohort of haemophilic men followed for up to 13 years from seroconversion

C. A. Sabina1, A. N. Phillipsa1, C. A. Leea2, G. Janossya3, V. Emerya4 and P. D. Griffithsa4

a1 Department of Public Health, Royal Free Hospital School of Medicine, Rowland Hill Street, London NW3 2PF, UK

a2 Haemophilia Centre and Department of Haematology, Royal Free Hospital and School of Medicine

a3 Department of Clinical Immunology, Royal Free Hospital School of Medicine

a4 Department of Virology, Royal Free Hospital School of Medicine

Summary

The effect of prior infection with cytomegalovirus (CMV) on progression of HIV disease in a cohort of 111 men with haemophilia was studied after 13 years followup. The relative hazards associated with CMV positivity on progression to AIDS, death and a CD4 count of 0·05 × 109/1 were 2·28, 2·42 and 2·34, respectively. CMV seropositive patients were significantly older than the seronegative and this was controlled for by using a Cox proportional hazards model. The relative hazards for the three endpoints decreased to 1·89, 1·82 and 1·93 respectively and were marginally non-significant (P = 0·05, 0·08 and 0·08 for the three endpoints respectively). We conclude that this cohort continues to show evidence of a ‘co-factor’ effect associated with prior infection with CMV which is confounded by age but not completely explained by age differences. The potential biological significance of these results is discussed in the context of recent controlled clinical trials which show a survival benefit from long-term high-dose acyclovir, a drug with activity in vivo against CMV and other herpesviruses.

(Accepted November 29 1994)

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