The impact of HIV on mortality rates in the complete UK haemophilia population UK Haemophilia Centre

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The impact of HIV on mortality rates in the
complete UK haemophilia populationUK
Haemophilia Centre Doctors Organisation
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• Design Prospective cohort study to estimate the
  effect of HIV-1 infection on subsequent mortality
  in a complete population
• Subjects A total of 7250 haemophilic males were
  registered in the UK Haemophilia Centre Doctors
  Organisation database, 1977-1998. In the early
  1980s, 1246 were infected with HIV-1 from
  contaminated clotting factor concentrate.

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• Results-1 During 1977-1984 annual mortality in
  severely haemophilic males was 0.9. For those
  with HIV, annual mortality increased
  progressively from 1985 reaching over 10 during
  1993-1996 before falling to 5 in 1997 -1999 (ie,
  after the introduction of effective treatment),
  whereas without HIV it remained approximately
  0.9 throughout 1985-1999. The large temporal
  changes in mortality with HIV were largely
  accounted for by HIV-related conditions.
• From 1997, after the introduction of effective
  treatment, substantial reductions occurred,
  although mortality from liver disease remained
  high.

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• Results-2 For moderately/mildly haemophilic
  males the annual mortality was 0.4 during
  1977-1984. Without HIV it remained approximately
  0.4 throughout 1985-1999, but with HIV it was
  similar to that in severe haemophilia with HIV.

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• Results-3 A strong gradient in mortality was
  observed with age at infection. This remained
  even after taking into account the mortality that
  would have been expected without HIV.

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• Results (4) Most of the population (both those
  infected with HIV and those not infected) were
  infected with hepatitis C.
• Without HIV annual liver disease mortality
  remained below 0.2 throughout 1985-1999, but
  with HIV it was 0.2 during 1985-1990, 0.8
  during 1991-1996, and 0.8 during 1997-1999.

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Annual death rates () in HIV-infected males with
haemophilia in the UK
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Conclusions

• These data provide a direct estimate of the
  effect of HIV-1 infection on subsequent mortality
  in a population with a high prevalence of
  hepatitis C.
• From approximately 3 years after HIV infection,
  large, progressive increases in mortality were
  seen.

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• UK Haemophilia Centres contributing data
  to this study
• Aberdeen, Ashford, Bangor, Barnstaple,
  Basingstoke, Bath, Bedford, Belfast (Adults
  Children), Birmingham (Adults Children),
  Blackburn, Bournemouth/Poole, Bradford (Adults
  Children), Brighton, Bristol (Adults Children),
  Bury St. Edmunds, Camberley, Cambridge,
  Canterbury, Cardiff, Carlisle, Carshalton,
  Chelmsford, Chertsey, Chichester, Colchester,
  Coventry, Derby, Dorchester, Dundee, Eastbourne,
  Edinburgh (Adults Children), Epsom, Exeter,
  Glasgow (Adults Children), Harlow, Harrogate,
  Harrow, Hereford, Hillingdon, Huddersfield, Hull,
  Inverness, Ipswich, Kettering, Kingston-upon-Thame
  s, Lancaster, Leeds (Adults Children),
  Leicester, Lincoln, Liverpool (Adults
  Children), London (Great Ormond Street,
  Hammersmith, Kings, Lewisham, Royal Free, Royal
  London, St George's, St Mary's, St Thomas',
  University), Luton, Manchester (Adults
  Children), Medway, Milton Keynes, Middlesborough,
  Newcastle-upon-Tyne, Newport, Northampton,
  Norwich, Nottingham, Oxford, Peterborough,
  Plymouth, Portsmouth, Salisbury, Sheffield
  (Adults Children), Shrewsbury, Southampton,
  Southend, Leonards-on-Sea, Stoke-on-Trent,
  Sunderland, Swansea, Taunton/Yeovil, Thornton
  Heath, Torquay, Truro, Tunbridge Wells,
  Whitehaven, Winchester, Wolverhampton, Worcester,
  Worthing, York.

AIDS 2004, 18 525-533