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Validation of the proposed World Health Organization staging system for HIV disease and infection in a cohort of intravenous drug users.
AIDS. 1994 Aug; 8(8):1129-33.In Maryland, researchers aimed to determine whether clinical staging using the World Health Organization (WHO) proposed system would predict progression from HIV seropositivity to AIDS. They used product-limit estimates with right censoring to compare time of progression to AIDS among 694 intravenous drug users (IVDUs) in Baltimore who were HIV-positive by January, 1992, from each of the WHO proposed system's 1st 3 clinical stages. The researchers used Cox proportional hazard methods to examine the effect of race, sex, age, and baseline injection status on the risk of progression by clinical stage. Most of the participants were Black (95%), poor (legal income of <$5000/year, 78%), and male (75.8%). Many (35%) were homeless. At the time of the index visit, the proportion of IVDUs at WHO stages 1, 2, and 3 were 49%, 10%, and 41%, respectively. At the end of the study period, 67 (9.7%) of all IVDUs had progressed to AIDS. The product-limit estimates for progression to AIDS over a 3-year period indicate that the risk of progression to AIDS increases as the stages advance (6.5% for stage 1, 10.4% for stage 2, and 17.1% for stage 3; logrank p = .003). Age, race, sex, and baseline injection status did not affect the association between initial clinical stage and progression. The hazard for progression to AIDS relative to stage 1 was 1.51 for stage 2 and 2.39 for stage 3. These findings suggest that WHO'S proposed staging system for HIV infection and AIDS may predict progression from HIV seropositivity to AIDS using clinical criteria alone. This system would be most useful in areas with limited routine access to laboratory markers (e.g., CD4 counts), such as in many developing countries.