Predicting survival in AIDS: refining the model |
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Authors: | Hutchinson SJ; Brettle RP; Gore SM |
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Institution: | MRC Biostatistics Initiative for AIDS and HIV in Scotland, Centre for HIV Research, Edinburgh, UK. |
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Abstract: | We tested the validity of a previously-published AIDS staging system by
examining AIDS-defining diseases (ADDs) and CD4 counts as prognostic
factors for survival of the 248 AIDS patients in the Edinburgh City
Hospital Cohort, of whom 56% were injecting drug-users (IDUs). Cox
regression was used to model the proportionality of risk of death as the
CD4 count declined and more ADDs were experienced, and dependence upon
post-AIDS treatment. Using the system of Mocroft et al. (Lancet 1995;
346:12-17) to grade severity, our data were well enough modelled, but we
suggest: (i) regrading of HIV dementia (RR 3.9, 95% CI 2.5-6.0), mainly
attributed to the drug users, to a very severe ADD; (ii) reduction in risk
from zidovudine (RR 0.7, 95% CI 0.5-1.0) during AIDS follow-up for patients
starting treatment at or after AIDS diagnosis; (iii) improved management of
first mild ADDs (from 1987-89 to 1994-95: 40% reduction in IDUs appearing
with mild index diseases, and an approximate three-fold reduction in risk
associated with a mild ADD). This study supports previous findings on the
significance of ADDs and lowest CD4 count in predicting the lifetime of
AIDS patients.
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