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AIDS and haemophilia.

The prevalence of overt AIDS in haemophilia A in the USA is about 3% treated patients and about 2% in UK. Nevertheless up to 90% of patients with haemophilia A treated with commercial concentrates of factor VIII prepared from the blood of paid donors are seropositive to the AIDS-associated virus LAV/HTLV III. Infection seems to have commenced in 1978 in USA and in 1980 in Europe. The accession rate to the symptomatic group is not known. Seropositivity is much lower in patients treated with blood products derived from voluntarily donated blood but such patients, even when seronegative, often show cellular immune defects. An additional immunosuppressive agent in factor VIII concentrates may be responsible for this and could predispose to LAV infection. AIDS, immune defects and seropositivity are less common in patients with haemophilia B even when treated with factor IX concentrate derived from paid donors. The reasons for this anomaly are not known. The diagnosis, social, family and counselling problems of infected patients are surveyed and the prospects for effective anti-viral or immunotherapy assessed. Treatment policies using heat-treated factor concentrates and the impact of donor screening are reviewed. It is concluded that the outlook for uninfected haemophiliacs with regard to AIDS is now good.