Document 0256
 DOCN  M9590256
 TI    Infection with some co-pathogens influences HIV-related mortality.
 DT    9509
 AU    Mallon DF; Mallal SA; James IR; French MA; Dept of Clinical Immunology,
       Royal Perth Hospital, W. Australia.
 SO    Annu Conf Australas Soc HIV Med. 1994 Nov 3-6;6:267 (unnumbered poster).
       Unique Identifier : AIDSLINE ASHM6/95291843
 AB    OBJECTIVE: To describe the prevalence of prior infection with HBV, HCV,
       CMV, T. gondii and T. pallidum in a cohort of HIV-infected subjects at
       presentation and determine the influence of these infections on
       subsequent HIV-related mortality. DESIGN: Serum antibodies to these
       pathogens were measured at the time participants were enrolled in the
       Western Australian HIV Cohort study and the subjects were followed
       prospectively. RESULTS: Past infection with pathogens other than HIV was
       very common in this cohort with more than 95% of patients having
       serological evidence of past infection with at least one other pathogen.
       Eighty-nine percent of patients tested had antibodies to CMV and 34% to
       T. gondii, 46% had HBsAb, 59% had HBcAb and 6.4% had HBsAg present.
       Nineteen percent of patients tested had antibodies to HCV and 23% of
       patients had serological evidence of prior syphilis (TPHA positive), of
       whom 15% had a positive RPR test. When corrected for patients' age, CD4+
       T-cell percentage and serum IgA concentration at presentation, the
       presence of past T. gondii or syphilis infection or the presence of
       HBsAg were all independently predictive of shorter survival times
       (relative hazards 3.1, 4.0 and 4.3, p values 0.018, 0.003 and 0.01
       respectively). Similar findings were obtained when cases of toxoplasma
       encephalitis were excluded from the analysis (relative hazards 3.3, 4.9
       and 6.8, p values 0.041, 0.001 and 0.003 respectively). Compared to
       having none of these three infections, the relative hazard of
       HIV-related death adjusted for age, CD4 T-cell percentage and serum IgA
       concentration at presentation was 3.9 when one infection was present and
       18.5 when two or more infections were present. The presence of other
       antibodies (CMV IgG, HBcAb, HCV IgG or RPR) was not associated with a
       significant increase in HIV-related mortality. CONCLUSIONS: The majority
       of patients presenting with HIV infection have evidence of past
       infection with other pathogens. Prior infection with Toxoplasma gondii
       or syphilis or persistent Hepatitis B infection are associated with
       rapid progression of HIV disease to death, but prior infection with CMV
       or HCV is not. Patients with multiple infections have the most rapid
       disease progression.
 DE    Antibodies/BLOOD  AIDS-Related Opportunistic
       Infections/IMMUNOLOGY/*MORTALITY  *Cause of Death  Cohort Studies  CD4
       Lymphocyte Count  Follow-Up Studies  Human  HIV
       Infections/IMMUNOLOGY/*MORTALITY  Prospective Studies  Survival Rate
       MEETING ABSTRACT

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).