CLINICAL TRIALS AND OBSERVATIONS

Mortality rates and causes of death among all HIV-positive individuals with hemophilia in Canada over 21 years of follow-up Donald M. Arnold, Jim A. Julian, and Irwin R. Walker, for the Association of Hemophilia Clinic Directors of Canada Many individuals with hemophilia were infected with human immunodeficiency virus (HIV) in the early 1980s through contaminated blood products. Most also were co-infected with hepatitis C virus (HCV). Deaths among the entire cohort of HIV-positive hemophiliacs in Canada up to 2003 are described. Using registry data, we analyzed Kaplan-Meier survival curves, determined the effect of age at HIV sero-conversion on mortality, and described cause-specific proportional mortality pat-terns over time. Of 2427 Canadians with hemophilia, 660 (27.2%) were HIV-positive, of whom 406 (61.5%) died. In contrast, 114 (6.5%) deaths occurred in HIV-negative controls. Median age at HIV seroconversion was 20 (range, < 1-67 years), and median survival was 15.0 years (95 % confidence interval, 13.6-16.4 years). Younger age at HIV seroconver-sion was associated with improved sur-vival; however, this finding was not ex-plained by differences in causes of death across age groups. Following the intro-duction of highly active antiretroviral therapy, the proportion of deaths due to acquired immune deficiency syndrome has decreased, while the proportion of deaths due to liver disease has increased. There were 1134 HCV-positive individu-als, of whom only 444 (39.2%) were also HIV-positive. Liver disease is a growing health concern among many hemophili-acs, not only those who are HIV-positive