DEVELOPMENT OF AIDS IN A COHORT OF HIV-SEROPOSITIVE HOMOSEXUAL MEN IN AUSTRALIA

The Sydney AIDS Prospective Study is a cohort study of 1057 homosexual men enrolled between February 1984 and January 1985. By June 30, 1989, 111 (26.8%) of the 414 men who were seropositive for antibodies to human immunodeficiency virus (HIV) at enrolment had developed the acquired immunodeficiency syndrome (AIDS). On univariate analysis the following baseline factors were significantly associated with subsequent development of AIDS: splenomegaly; a lymphocyte count less than 1500 x 106/L; a percentage of CD4+ cells less than 20% of the total lymphocyte count; an absolute number of CD4+ cells less than 200 x 106/L; and a CD4+:CD8+ ratio less than 1.00. In a proportional hazards model the following factors retained significance: a lymphocyte count less than 1500 x 106/L; an absolute number of CD4+ cells less than 200 x 106/L; and a CD4+:CD8+ ratio less than 1.00. A CD4+ cell count less than 200 x 106/L carried the greatest relative risk (3.99) for the development of AIDS. This study has confirmed that the appreciable rates of progression to AIDS demonstrated in overseas cohorts of HIV-infected persons also apply in the Australian context. A number of laboratory variables was found to be predictive for the subsequent development of AIDS. As we were not able to determine accurately whether subjects were receiving antiretroviral treatment or prophylaxis for opportunistic infections the observed rates in this study should be seen as minimum estimates. These findings have important implications for HIV-infected persons and for public health planning, and emhasise the need for regular clinical monitoring and T-cell subset enumeration in HIV-infected persons.