The natural history of HIV disease in haemophilia

Patients with haemophilia, particularly that due to factor VIII deficiency, have been exposed to a wide range of infective agents transmitted through blood products that have in other ways revolutionized their care. The most devastating of these transfusion transmitted infections has been the human immunodeficiency virus (HIV). AIDS in haemophilic patients was first described in 1982 and it has significantly reduced the life expectancy of these patients. In this article, the impact of the HIV epidemic within haemophilic patients treated with coagulation factor concentrate is discussed. The effect of age at time of exposure to HIV and the value of disease markers such as P24 antigenaemia and CD4 counts are considered in detail. The relationship between HIV disease and coexisting hepatitis C infection is described and the incidence of secondary malignancies such as lymphoma is reviewed. In this patient population the recent elucidation of the life cycle and dynamics of HIV as well as the technologial advances in the development of the HIV RNA PCR assay for HIV viral load have revolutionalized the diagnosis, prognosis, management and treatment of HIV infection.