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HIV patients who are also infected with the hepatitis C virus (HCV) may be unable to eliminate the hepatitis C virus, according to a study of 207 HIV-positive and 126 HIV-negative hemophiliacs. This study also showed that higher HCV RNA levels are linked to increased liver inflammation.

The authors examined various factors relevant to HIV infection (HIV RNA, CD4+ lymphocytes, chemokine receptors) to determine the progression of the disease and relationship to each other. The subjects were 207 HIV-positive hemophiliacs.

People who have low blood levels of HIV RNA one or two years after becoming HIV-positive may be less likely to develop AIDs. Researchers measured HIV RNA in blood samples taken from 165 hemophiliacs up to three years after they had been infected and followed them until they developed AIDS. Ten years after infection, 72% of those with 100,000 or more copies of HIV RNA per milliliter (ml) had AIDS, compared to 52% of those with 10,000 to 99,999 copies/ml, 22% of those with 1,000 to 9,999 copies/ml and none of those with fewer than 1,000 copies/ml.

Individuals infected with human immunodeficiency virus (HIV) type 1 may have a higher risk of developing non-Hodgkin's lymphoma (NHL) and Kaposi's sarcoma than individuals not infected with HIV. Out of 1,701 patients with hemophilia and related blood-clotting disorders, 1,065 were HIV-positive, and 636 were HIV-negative. Since October 1982, 12 HIV-positive patients had NHL and two had Kaposi's sarcoma. But none of the HIV-negative patients had either disease. The incidence of NHL in HIV-positive patients increased exponentially with time since HIV infection, and the risk of developing NHL was highest in older HIV-positive patients. HIV-positive patients did not have a higher incidence of other types of cancer than HIV-negative patients. Hemophiliacs do not have a higher risk of developing cancer than healthy individuals., Objective.--To determine the types and rates of cancers occurring in excess in the presence of infection with the human immunodeficiency virus type 1 (HIV-1). Design.--Cohort analytic study of HIV-infected and HIV-uninfected subjects followed for up to 12 years. Setting.--Fifteen hemophilia treatment centers. Patients.--A total of 1701 patients with hemophilia, of whom 1065 (63%) were HIV-1 seropositive. Main Outcome Measures.--Morphologic classification and incidence rates of cancers. Main Results.--The incidence of non-Hodgkin's lymphoma after HIV seroconversion averaged 0.15 case per 100 person-years (95% confidence interval [CI], 0.08 to 0.25) and rose exponentially with increasing duration of HIV infection. Although the greatest absolute risk of lymphoma was in the oldest age group, the relative increase compared with general population rates was 38-fold in subjects 10 to 39 years old and 12-fold in older subjects (P

Infection by human immunodeficiency virus type 1 (HIV-1) can be transmitted by transfusion of blood or blood products contaminated with HIV-1. Persons infected with HIV-1 by blood transfusion can then transmit the virus to their sexual partners but rarely to other members of the household. The incidence of HIV infection was assessed in 505 people who had sexual contact with or were exposed to HIV-infected patients with hemophilia, a blood disorder commonly treated by blood transfusion. These subjects came from a total of 349 households. At the beginning of the study, 20 of 201 sexual partners of HIV-infected hemophiliacs had antibodies to HIV-1, indicating HIV infection. During the follow-up period, 151 sexual partners remained free of HIV infection, even though 87 percent of those who tested negative engaged in unprotected sexual intercourse. HIV infection was not present in 304 nonsexual contacts, including 108 parents of HIV-infected hemophiliacs, and did not occur during the follow-up period in 263 nonsexual contacts. These findings show that HIV-infected hemophiliacs may unwittingly transmit HIV infection to their sexual partners early in the course of the disease. Transmission of HIV infection by HIV-infected hemophiliacs was not related to the numbers of virus particles in the blood. In addition, the risk of HIV transmission from infected hemophiliacs to nonsexual contacts is very low. (Consumer Summary produced by Reliance Medical Information, Inc.)

Hemophilia A is a relatively common genetic disorder that affects the blood clotting process, resulting in an tendency to hemorrhage. As an X-linked disorder, it occurs predominantly in men, affecting about 1 in 10,000 males. In its most severe form, it is a life-threatening illness. Patients with hemophilia A do not possess adequate activity of clotting factor VIII. The introduction of factor VIII treatment has resulted in a better quality of life and longer life expectancy for hemophilia patients. However, since the factor VIII has been obtained from blood, hemophilia patients have always been at higher risk for viral hepatitis and immunization against alloantigens. More recently, AIDS has been added as one of the diseases hemophiliacs may contract from contaminated factor VIII. This has provided an incentive to develop recombinant factor VIII, produced by bacteria using the human factor VIII gene. Since recombinant factor VIII does not come from human blood, the opportunity for the transmission of viral diseases is effectively eliminated. Two research groups have reported success with the cloning of factor VIII, one of the largest molecules cloned to date. Now, investigation of the effectiveness of recombinant factor VIII in treating 107 hemophiliacs has revealed that the new substance is safe and effective. The new recombinant factor VIII was no less effective or long-lasting in the blood than the traditional preparations. Furthermore, the new preparation proved to be no more antigenic than blood-derived factor VIII. As is the case with insulin and other protein factors, one of the major impediments to continued use of a factor VIII preparation is the development of antibodies. A small fraction of patients with hemophilia develop antibodies against factor VIII, which not only bind to the molecule, but inhibit its function. Such inhibitor antibodies developed in eight of the patients; the antibodies were strong in only one. This is comparable to the incidence of inhibitor antibodies seen using blood-derived factor VIII. (Consumer Summary produced by Reliance Medical Information, Inc.)

AIDS (acquired immunodeficiency syndrome) has been shown to be caused by the human immunodeficiency virus (HIV). However, the onset of the disease does not necessarily occur shortly after the person becomes infected. Infection by the virus itself is judged by the presence of specific antibodies that are produced by the body against the infection, and by the number of a particular class of lymphocytes (a type of white blood cell; the measurement is known as the CD4+ cell count). The rate of individuals developing AIDS after detection of HIV antibodies in their blood (seroconversion) has been studied in a group of individuals for whom the precise time of infection is known, namely hemophiliacs. Unlike individuals who have a high-risk lifestyle (e.g., homosexuals or drug users), patients with hemophilia usually become infected with HIV by medical treatment with contaminated human blood products; treatment records often allow determination of the time of infection. Out of a group of 1,219 individuals with hemophilia or similar conditions, 319 individuals for whom the date of HIV seroconversion was known were studied in detail. Statistical analysis of this group led to the finding that the risk of AIDS is directly related to age in individuals that seroconvert. The risk of an individual developing full-blown AIDS after infection is 2.67 per 100 person-years for the total population, 0.83 for persons between 1 and 11, and 5.66 for individuals 35 to 70. The common predictors, the number of CD4+ lymphocytes and a decrease in the quantity of antibodies produced against the virus (anti-p24 or anti- gp120), were valid indicators of increasing risk of AIDS in adults. Adolescents, on the other hand, had a lower rate of antibody loss, and a lower rate of AIDS after loss of anti-p24. There is thus evidence that the disease is more devastating among older individuals, and that children and adolescents are more resistant to developing AIDS. The article also speculates on the meaning of these findings, and suggests that the problems of AIDS are related to the re-initiation of previous infections that have been accumulated during a longer life.