The impact of HIV on mortality rates in the complete UK haemophilia population UK Haemophilia Centre Doctors Organisat

1. The impact of HIV on mortality rates in the complete UK haemophilia populationUK Haemophilia Centre Doctors’ Organisation

2. Design: Prospective cohort study to estimate the effect of HIV-1 infection on subsequent mortality in a complete population Subjects: A total of 7250 haemophilic males were registered in the UK Haemophilia Centre Doctors’ Organisation database, 1977-1998. In the early 1980s, 1246 were infected with HIV-1 from contaminated clotting factor concentrate.

4. Results-1: During 1977-1984 annual mortality in severely haemophilic males was 0.9%. For those with HIV, annual mortality increased progressively from 1985 reaching over 10% during 1993-1996 before falling to 5% in 1997 -1999 (ie, after the introduction of effective treatment), whereas without HIV it remained approximately 0.9% throughout 1985-1999. The large temporal changes in mortality with HIV were largely accounted for by HIV-related conditions. From 1997, after the introduction of effective treatment, substantial reductions occurred, although mortality from liver disease remained high.

6. Results-2: For moderately/mildly haemophilic males the annual mortality was 0.4% during 1977-1984. Without HIV it remained approximately 0.4% throughout 1985-1999, but with HIV it was similar to that in severe haemophilia with HIV.

9. Results-3: A strong gradient in mortality was observed with age at infection. This remained even after taking into account the mortality that would have been expected without HIV.

13. Results (4): Most of the population (both those infected with HIV and those not infected) were infected with hepatitis C. Without HIV annual liver disease mortality remained below 0.2% throughout 1985-1999, but with HIV it was 0.2% during 1985-1990, 0.8% during 1991-1996, and 0.8% during 1997-1999.

14. Annual death rates (%) in HIV-infected males with haemophilia in the UK

15. Conclusions These data provide a direct estimate of the effect of HIV-1 infection on subsequent mortality in a population with a high prevalence of hepatitis C. From approximately 3 years after HIV infection, large, progressive increases in mortality were seen.

16. UK Haemophilia Centres contributing data to this study Aberdeen, Ashford, Bangor, Barnstaple, Basingstoke, Bath, Bedford, Belfast (Adults & Children), Birmingham (Adults & Children), Blackburn, Bournemouth/Poole, Bradford (Adults & Children), Brighton, Bristol (Adults & Children), Bury St. Edmunds, Camberley, Cambridge, Canterbury, Cardiff, Carlisle, Carshalton, Chelmsford, Chertsey, Chichester, Colchester, Coventry, Derby, Dorchester, Dundee, Eastbourne, Edinburgh (Adults & Children), Epsom, Exeter, Glasgow (Adults & Children), Harlow, Harrogate, Harrow, Hereford, Hillingdon, Huddersfield, Hull, Inverness, Ipswich, Kettering, Kingston-upon-Thames, Lancaster, Leeds (Adults & Children), Leicester, Lincoln, Liverpool (Adults & Children), London (Great Ormond Street, Hammersmith, Kings, Lewisham, Royal Free, Royal London, St George's, St Mary's, St Thomas', University), Luton, Manchester (Adults & Children), Medway, Milton Keynes, Middlesborough, Newcastle-upon-Tyne, Newport, Northampton, Norwich, Nottingham, Oxford, Peterborough, Plymouth, Portsmouth, Salisbury, Sheffield (Adults & Children), Shrewsbury, Southampton, Southend, Leonards-on-Sea, Stoke-on-Trent, Sunderland, Swansea, Taunton/Yeovil, Thornton Heath, Torquay, Truro, Tunbridge Wells, Whitehaven, Winchester, Wolverhampton, Worcester, Worthing, York.