XI International Conference on AIDS(http://www.interchg.ubc.ca/aids11/homepage.html)
XI International Conference on AIDS(internet-link: "http://www.interchg.ubc.ca/aids11/homepage.html") (Abstract in press)
Keywords: HIV, AIDS, back-calculation, hemophilia, non-progressor, transmission efficacy, heterosexuals
Objective: Hemophiliacs are an ideal cohort to search for evidence for non-progressors (asymptomatic over >25 years) and male-to-female transmission, because they (1) became infected within a short period of time early in the epidemic (approx. 1981-1984), (2) are unlikely to be exposed to other risk factors, (3) are under ongoing medical supervision, and (4) are not stigmatized and often (e.g. in Germany) even entitled to financial benefits when tested HIV positive (HIV+).
Material and Methods: We analyze data from different sources, e.g. the AIDS register at the Robert-Koch-Institute (RKI), an ongoing surveillance among physicians treating hemophiliacs, and different organizations dealing with compensation applications.[1] RKI AIDS cases are corrected for reporting delays changing over time.[2] RKI AIDS deaths are adjusted for underreporting under the assumption of <4 years life expectancy after AIDS (European definition). HIV incidence is 'back-projected' under the assumption of 0-25 years incubation time and increasing treatment effects.
Results: Back-projection yields 950 infections (peak incidence: 1982/83). Among the approx. 3000 hemophiliacs in 1981-1984, however, 1400 (42%) tested HIV+. Of these, 800 (57%) applied for compensation in 1994. Until Dec. 95, 650 (46%) have died (500 after and 150 without developing AIDS). Death rates declined from 50 and 18, resp., in 1990 to 40 and 15 in 1995. Less than 10% have infected a female partner, e.g. the basic reproduction number is at most approx. equal to 1.[6]
Conclusions: Unless the AIDS hazard rate should be sharply increasing 15 years after infection, the only postulate allowing to explain these findings is that only 200 more AIDS cases are to be expected over the next 15 years, or, equivalently, that among those not dying for other reasons, approx. 25% become non-progressors. Although the factors leading to this low rate of developing AIDS are not entirely understood, the findings contribute further evidence to the assertion that some HIV infected persons might have a normal life expectancy, although the proportion may be less for other risk groups. The low reproduction number adds evidence to the assertion that use of condoms and/or spermicides during the first three months of a relationship would be sufficient to prevent HIV from becoming endemic among European heterosexuals.[3 -
[1] SCHARRER, I., SCHRAMM, W. (1995, Eds.) 25. Hämophilie-Symposion: Hamburg 1994. Berlin, D: Springer
[2 SEYDEL, J., KR&AUML;MER, A., ROSENBERG, P.S., WITTKOWSKI, K.M., GAIL, M.H. (1994) Backcalculation of the number infected with human immunodeficiency virus in Germany. Journal of Acquired Immune Deficiency Syndromes 7 74-78
[3a] WITTKOWSKI, K.M. (1988) Über die Bedeutung von Detergentien für die HIV-Prophylaxe unter Heterosexuellen. (On the impact of detergents on HIV prevention strategies for heterosexuals.) AIDS-Forschung 3
[4] WITTKOWSKI, K.M. (1989) Preventing the heterosexual spread of AIDS: What is the best advice if compliance is taken into account? AIDS 3 :143-145
[5] WITTKOWSKI, K.M. (1995) The potential of nonoxinol 9 for the prevention of HIV infection reconsidered. AIDS 9
[6a] WITTKOWSKI, K.M. (1995) Epidemiologie von HIV in Deutschland. Das Gesundheitswesen 57
[6b] WITTKOWSKI, K.M. (1995) Die Ausbreitung von HIV unter Heterosexuellen in Deutschland anhand der Zahlen des AIDS-Fallregisters, Stand 31.07.95. Das Gesundheitswesen 57 : 528 (abstract)
[6d] WITTKOWSKI, K.M. (1996a) Epidemiologie von HIV in Deutschland (Stand 30.06.95) -Ausbreitung unter Heterosexuellen und Aussagekraft von HIV-Screening-Programmen. Das Gesundheitswesen 58 (in press)
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XI International Conference on AIDS(http://www.interchg.ubc.ca/aids11/homepage.html)