Clinical and immunological features of human immunodeficiency virus infection in patients from Bangkok, Thailand

Abstract

To assess the association between the CD4 count and clinical diseases in a cohort of Thai patients. In all, 1902 patients who presented with human immunodeficiency virus (HIV) infection at the Chulalongkorn University Hospital in Bangkok were investigated. At the time of presentation 295 (15.5%) patients had acquired immunodefidency syndrome (AIDS) and there was a highly significant tendency for lower CD4 counts in this group (median 67/mm³) than in patients free of AIDS (median 369/mm³). A total of 757 patients had data available on follow-up and were free of AIDS at the first visit. During a median follow-up of 0.9 years, 110 developed AIDS or AIDS-related death (12.2/100 person years). Subjects with CD4 count 3 at initial visit showed over a ninefold increase in risk of developing AIDS compared to subjects with levels ≥500/mm³ (relative risk [RR] 9.1; 95% CI: 5.4–16.0). The rate/100 person years was 47.1 compared with 6.0 in subjects with levels ≥500/mm³. After adjusting for initial CD4 count, homosexual men showed over a twofold increase in risk of developing AIDS compared to heterosexuals (RR = 2.4; 95% CI: 1.6–4.4) and intravenous drug users (IVDU) showed nearly a twofold increase (RR = 1.8; 95% CI: 0.9–3.9). The increased risk in homosexual men persisted even after further adjustment for clinical stage (RR = 2.2; 95% CI: 1.3–3.7) but the increased risk in IVDU was attenuated (RR = 1.5; 95% CI: 0.7–3.2) although it remained increased albeit non-significantly. Men tended to progress faster to AIDS than women but the difference was not significant. However, the faster progression in homosexual men was seen even when compared to heterosexual men only The rate of progression to AIDS according to CD4 count group at baseline in this Thai cohort is broadly comparable with Western cohorts. It appears that heterosexuals in Thailand show slower progression to AIDS than homosexual men.