Skip to main content
SpringerLink
Log in

Prognostic factors in acquired immunodeficiency syndrome

  • Original Articles
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

To identify prognostic factors in acquired immunodeficiency syndrome (AIDS), the authors studied an inception cohort of 45 patients in a non-endemic area (Group I). The probability of survival was 67% six months after the diagnosis of AIDS and 32% at 12 months. As shown by multivariate Cox regression analysis, survivals were shorter (p<0.01) in patients 35 years old or older and in those who had anemia when AIDS was diagnosed. In patients with neither of these poor prognostic factors, the 12-month survival was 64%; in patients with one factor, it was 22%; and in patients with both factors, 0%. The prognostic significance of these two factors was validated in a second inception cohort of 50 patients (Group II): in patients with zero, one, and two poor prognostic factors, the 12-month survivals were 80%, 58%, and 26%, respectively. Other poor prognostic factors in Group I included disseminatedMycobacterium avium-intracellulare and the development of new opportunistic infections or neoplasms. The authors conclude that clinically important prognostic factors can be identified in AIDS patients. These findings should be considered in planning therapeutic trials and in counseling patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Moss AR, McCallum G, Volberding PA, Bachetti P, Dritz S. Mortality associated with mode of presentation in the acquired immune deficiency syndrome. J Natl Cancer Inst 1984;73:1281–4.

    PubMed  CAS  Google Scholar 

  2. Marasca G, McEvoy M. Length of survival of patients with acquired immunodeficiency syndrome in the United Kingdom. Br Med J 1986;292:1727–9.

    Article  CAS  Google Scholar 

  3. Rivin BE, Monroe JM, Hubschman MP, Thomas PA. AIDS outcome: a first follow-up (letter). N Engl J Med 1984;311:857.

    PubMed  CAS  Google Scholar 

  4. Safai B, John RG, Myskowski PL, et al. The natural history of Kaposi’s sarcoma in the acquired immunodeficiency syndrome. Ann Intern Med 1985;103:744–50.

    PubMed  CAS  Google Scholar 

  5. Rothenberg R, Woelfel M, Stoneburner R, Milberg J, Parker R, Truman B. Survival with the acquired immunodeficiency syndrome: experience with 5833 cases in New York City. N Engl J Med 1987;317:1297–302.

    Article  PubMed  CAS  Google Scholar 

  6. Centers for Disease Control. Update on acquired immune deficiency syndrome (AIDS). United States. MMWR. 1982;31:507–8,513–4.

    Google Scholar 

  7. Centers for Disease Control. Revision of the case definition of acquired immunodeficiency syndrome for national reporting. United States. MMWR. 1985;34:373–4.

    Google Scholar 

  8. Harrell FE Jr. The PHGLM procedure. In: SUGI supplemental user’s guide. Cary, NC: SAS Institute, 1983;267–94.

    Google Scholar 

  9. Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Statist Assoc 1958;53:839–43.

    Article  Google Scholar 

  10. Department of Clinical Epidemiology and Biostatistics, McMaster University. How to read clinical journals: III. To learn the clinical course and prognosis of disease. Can Med Assoc J 1981;124:869–72.

    Google Scholar 

  11. Mathur-Wagh U, Spigland I, Sacks HS, et al. Longitudinal study of persistent generalized lymphadenopathy in homosexual men: relation to acquired immunodeficiency syndrome. Lancet 1984;1:1033–8.

    Article  PubMed  CAS  Google Scholar 

  12. Jaffe HW, Darrow, WW, Echenberg DF, et al. The acquired immunodeficiency syndrome in a cohort of homosexual men. A six year follow-up study. Ann Intern Med 1985;103:210–4.

    PubMed  CAS  Google Scholar 

  13. Francis DP, Jaffe HW, Fultz PN, Getchell JP, McDougall JS, Feorino PM. The natural history of infection with the lymphadenopathy associated virus human T-lymphotropic virus type III. Ann Intern Med 1985;103:719–22.

    PubMed  CAS  Google Scholar 

  14. Goedert JJ, Biggar RJ, Weiss SH, et al. Three year incidence of AIDS in five cohorts of HTLV-III-infected risk group members. Science 1986;231:992–5.

    Article  PubMed  CAS  Google Scholar 

  15. Taylor JG, Schwartz K, Detels R. The time from infection with human immunodeficiency virus (HIV) to the onset of AIDS. J Infect Dis 1986;154:694–7.

    PubMed  CAS  Google Scholar 

  16. Wiley JA, Rutherford GW, Moss AR, Winklestein W. Age and cumulative incidence of AIDS among seropositive homosexual men in high incidence areas of San Francisco (abstr). Proceedings of 3rd International Conference on AIDS. Washington, DC: Department of Health and Human Services and the World Health Organization, 1987;206.

    Google Scholar 

  17. Kishimoto S, Tomino S, Inomata K, et al. Age-related changes in the subsets and functions of human T lymphocytes. J Immunol 1978;121:1773–80.

    PubMed  CAS  Google Scholar 

  18. Volberding PA, Kaslow K, Bilk M, et al. Prognostic factors in staging Kaposi’s sarcoma in the acquired immune deficiency syndrome (abstr). Proc Am Soc Clin Oncol 1984;3:51.

    Google Scholar 

  19. Spivak JL, Bender BS, Quinn TC. Hematologic abnormalities in the acquired immune deficiency syndrome. Am J Med 1984;77:224–8.

    Article  PubMed  CAS  Google Scholar 

  20. Fliedner VV, Higby DJ, Kim U. Graft-versus-host reaction following blood product transfusion. Am J Med 1982;72:951–61.

    Article  Google Scholar 

  21. Siegal FP, Lopez C, Fitzgerald PA, et al. Opportunistic infections in acquired immune deficiency syndrome result from synergistic defects of both the natural and adaptive components of cellular immunity. J Clin Invest 1986;78:115–23.

    Article  PubMed  CAS  Google Scholar 

  22. Polk BF, Fox R, Brookmeyer R, et al. Predictors of the acquired immunodeficiency syndrome developing in a cohort of seropositive homosexual men. N Engl J Med 1987;316:61–6.

    Article  PubMed  CAS  Google Scholar 

  23. Goedert JJ, Biggar RJ, Melbye M, et al. Effect of T4 count and cofactors on the incidence of AIDS in homosexual men infected with human immunodeficiency virus. JAMA 1987;257:331–4.

    Article  PubMed  CAS  Google Scholar 

  24. Zakowski P, Fligiel S, Berlin GW, Johnson BL. DisseminatedMycobacterium avium-intracellulare infection in homosexual men dying of acquired immunodeficiency. JAMA 1982;248:2980–2.

    Article  PubMed  CAS  Google Scholar 

  25. Greene JB, Sidhu GS, Lewin S, et al.Mycobacterium avium-intracellulare: a cause of disseminated life-threatening infection in homosexuals and drug abusers. Ann Intern Med 1982;97:539–46.

    PubMed  CAS  Google Scholar 

  26. Hawkins CC, Gold JWM, Whimbey E, et al.Mycobacterium avium complex infections in patients with the acquired immunodeficiency syndrome. Ann Intern Med 1986;105:184–8.

    PubMed  CAS  Google Scholar 

  27. Kocher J, Scavuzzo D, Horsburg CR, Murray HW, Roberts RB. Therapeutic response in AIDS patients with disseminatedMycobacterium avium-intracellulare (abstr). Clin Res 1986;34:522A.

    Google Scholar 

  28. Lane HC, Masur H, Gelman EP, et al. Correlation between immunologic function and clinical subpopulations of patients with the acquired immune deficiency syndrome. Am J Med 1985;78:417–22.

    Article  PubMed  CAS  Google Scholar 

  29. Taylor J, Afrasiabi R, Fahey JL, Korns W, Weaver M, Mitsuyasu R. Prognostically significant classification of immune changes in AIDS with Kaposi’s sarcoma. Blood 1986;67:666–71.

    PubMed  CAS  Google Scholar 

  30. Vadhan-Raj S, Wong G, Gnecco C, et al. Immunological variables as predictors of prognosis in patients with Kaposi’s sarcoma and the acquired immunodeficiency syndrome. Cancer Res 1986;46:4170–5.

    Google Scholar 

  31. Centers for Disease Control. Update: acquired immunodeficiency syndrome. United States. MMWR. 1986;35:49–50.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University Hospitals of Cleveland, 2074 Abington Road, 44106, Cleveland, OH

    C. Seth Landefeld MD

Authors
  1. Jay D. Wenger MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christopher C. Whalen MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael M. Lederman MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Thomas J. Spech MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. John T. Carey MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J. Walton Tomford MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. C. Seth Landefeld MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

Received from the Divisions of General Internal Medicine, Infectious Disease, and Geographic Medicine, Department of Medicine and the Clinical Analysis Project, University Hospitals of Cleveland; the Division of Infectious Disease, Department of Medicine, Cleveland Metropolitan General Hospital; the Department of Infectious Disease, Cleveland Clinic Foundation; and Case Western Reserve University School of Medicine. Dr. Wenger is now with the Centers for Disease Control, Atlanta, Georgia.

Supported in part by Grant Al-25314 from the NIAID.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wenger, J.D., Whalen, C.C., Lederman, M.M. et al. Prognostic factors in acquired immunodeficiency syndrome. J Gen Intern Med 3, 464–470 (1988). https://doi.org/10.1007/BF02595923

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02595923

Key words

Search

Navigation