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(although recent updates on their original publication have improved this). The CDC category A and B
(both asymptomatic individuals and those who have had symptoms of conditions attributed to or
complicated by HIV infection) are included in one group and the age ranges divided into four groups.
Their most recent study reports that the annual risk of developing a new AIDS-defining illness during the
first year after commencing HAART is around one per cent per annum for those whose 6-month CD4+
count is ≥350, viral load is <500 and where HIV transmission was not by intravenous drug use, the person
meets the criteria for CDC category A or B and is aged 16-29 years. The annual risk gradually decreases
over the subsequent four years. A calculator can be found on their web site at:
http://www.art-cohort-collaboration.org/6mhiv_form.html
Table 3.— Risk of developing AIDS in those who have had
no treatment or monotherapy
Rate = exp{-3.55 + [-0.21 √(CD4 cell count)] + 0.71 (log viral load) + 0.024(Age)}
12-month percentage risk of developing AIDS = [1 – exp(-1Rate)] x 100%
exp = exponential function
CD4 cell count = count x 106 cells/L
log = logarithm
viral load = copies/mL
Age = age in years
Example: A 25 year old pilot with CD4+ cell count of 450 and viral load of 5000 will have
a 12-month risk of developing AIDS of 0.84 per cent.
Rate = exp {-3.55 + [-0.21 x √450] + [0.71 x log5000]+ [0.024 x 25]} = 0.008
12-month percentage risk of developing AIDS = [1 – exp(-1 x 0.008 )] x 100% = 0.84%
A pilot aged 50 years with the same serological measurements would have a 12-month risk
of developing AIDS of 1.52 per cent.
ICAO Preliminary Unedited Version — November 2009 III-13-13
Derived from Phillips A. CASCADE Collaboration. Short-term risk of AIDS according
to current CD4 cell count and viral load in antiretroviral drug-naive individuals and
those treated in the monotherapy era. AIDS 2004 Jan 2. 18(1):51-8.
ICAO Preliminary Unedited Version — November 2009 III-13-14
Table 4.— Risk of Clinical Progression in those being treated
with combination Anti-Retroviral Therapy (cART)
CD4 Count (/mm3) >350 = 0 201−350 = +0.62 51−200 = +1.46 ≤50 = +2.44
Body Mass Index ≤18 = +0.80 18.1−25 = 0 >25 = −0.29
Viral Load
(copies/mL)
<500 = 0 ≥500 = +0.18
CD4 slope (3
month)
< −25/mm3 = +0.49 −25 to +25/mm3 = 0 >25/mm3 = +0.18
Anaemia
No = 0
Hb >14.0g/dL male
Hb >12.0g/dL female
Mild = +0.68
Hb 8.01−14.0g/dL male
Hb 8.01−12.0g/dL female
Severe = +1.02
Hb ≤8.0g/dL
Retroviral treatment
prior to cART
Yes = 0
No = −0.39
Currently taking
antiretrovirals
Yes = 0
No = +1.24
Infected with HIV Any route
except
intravenous
drug use = 0
Through
intravenous drug
use = +0.25
Prior diagnosis of
AIDS at starting
cART
No = 0 Yes = +0,19
Age Age × 0.027
Total Score % Risk of Clinical Progression in following 12 months (95% CI)
<1.5 0.5 (0.3-0.7)
1.5−2.99 1.4 (1.2-1.7)
3.0−4.49 6.3 (5.6-7.1)
≥4.5 20.0 (16.7-25.0)
Example: 30 year old man who has had no previous anti-retroviral therapy prior to cART, whose current CD4
count is 400, viral load 50, BMI 22 and no anaemia or previous AIDS defining illness. His CD4 slope increased
by 15/mm3 in the last three months and he is currently taking cART. Total score is 0.42 and therefore his risk of
progression for next 12 months is 0.5 per cent.
(Data from Mocroft A, Ledergerber B, Zilmer K, Kirk O, Hirschel B, Viard J-P, Reiss P, Francioli P, Lazzarin A,
Machala L, Phillips A, Lundgren J; for the EuroSIDA study group and the Swiss HIV Cohort Study Short-term
clinical disease progression in HIV-1-positive patients taking combination antiretroviral therapy: the
EuroSIDA risk-score. AIDS. 21(14):1867-1875, September 2007)
Both these studies indicate that the lowest risk of progression in the most favourable groups is about
0.5 to 1.0 per cent per annum (but not significantly less than 1 per cent) after commencing HAART. The
populations used in these studies are predominantly Western European, Israeli and Australian and so
caution may be required when applying the data to pilots from other regions. In addition the socioeconomic
level of pilots and air traffic controllers may differ from that of the study populations.
ICAO Preliminary Unedited Version — November 2009 III-13-15
It is recommended that CD4+ T cell count and viral load levels should be determined every three to four
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Manual of Civil Aviation Medicine 2(98)
