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Chihuahua Staffordshire Bull Terrier.Influence of HLA class II type andsmoking on the development of HIV-infection and progression to AIDS. TheAIDS Clinical Trial Group Study Group. The effect of HLA class II alleles on
susceptibility to HIV infection, progression to AIDS, and response toantiretroviral therapy was analyzed in an AIDS Clinical Trials Group cohort of1366 HIV-1-seropositive patients followed for 6 years. Previously reported
associations between HLA class II alleles and disease progression wereconfirmed. HLA-DR2-positive patients showed a greater than twofold risk ofprogression to AIDS (odds ratio, 2.2; 95% confidence interval, 1.7 to 2.9),
whereas HLA-DR4/8-positive patients had a fourfold increased risk ofprogression to AIDS (odds ratio, 4.3; 95% confidence interval, 2.8 to 6.5).
Interestingly, the most significant associations for DR2 and DR4/8 were among
patients who did not smoke. The risk of progression was significantly elevatedin patients with DR2 alleles in the presence or absence of smoking (odds ratio,6.7; 95% confidence interval, 4.2 to 10.4; odds ratio, 4.8; 95% confidence
interval, 2.8 to 8.4, respectively) but not in those with DR4/8 alleles. HLADR4/8-positive patients who smoked had a tenfold increase in risk ofprogression to AIDS (odds ratio, 10.3; 95% confidence interval, 3.1 to 34.3),
whereas patients who smoked and possessed either DR4/8 or DR2 alleles were
not at increased risk for progression to AIDS. A trend toward a faster rate of
disease progression in smokers was observed in HLA-DR2-positive patients;
this association became apparent only after one or more antiretroviral agents

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had been started (P =.03). DR2/4/8-positive patients treated with zidovudine
exhibited an increased risk of progression to AIDS compared with HLAmatched patients treated with did

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