Changes to AIDS dementia complex in the era of highly active antiretroviral therapy
Changes to AIDS dementia complex in the era of highly active antiretroviral therapy
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DOI：
10.1097/00002030-199907090-00015
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发表时间：
1999-07-09
期刊：
影响因子：
3.8
通讯作者：
Brew, BJ
中科院分区：
文献类型：
--
作者：
Dore, GJ;Correll, PK;Brew, BJ
目的：为了确定高效抗逆转录病毒疗法(HAART)对艾滋病痴呆综合征(ADC)相对于其他初始艾滋病定义疾病(ADI)的保护效果，对澳大利亚近年来的艾滋病报告数据进行了分析。最初设立了三个ADI小组：ADC；其他主要是中枢神经系统(CNS)ADI(弓形虫病和隐球菌病)；以及非CNS ADI。对每个ADI分组，比较HAART前时代(1992-1995)和HAART时代(1996和1997)ADI的比例和中位数。结果：澳大利亚的ADI在1994年达到峰值(n=1049)，逐渐下降到1996年(n=722)，1997年显著下降(n=367)。在1992-1995年间，ADC占初始ADI的4.4%，但在HAART引入后，ADC在1996年和1997年分别上升到6.0%和6.5%(P=0.02)。相比之下，其他中枢神经系统ADI的比例(1992-1995年，8.1%；1996年，6.0%；1997年，8.2%；P=0.41)在1992-1997年期间保持稳定。ADC确诊时的CD4细胞计数中位数从1992-1995年的70/mm(3)增加到1996年的120/mm(3)和1997年的170/mm(3)(P=0.04)。尽管在此期间，其他中枢ADI(40~60/mm(3)；P=0.02)和非中枢ADI(60~70/mm(3)；P=0.02)的CD4细胞计数中位数也显著增加，但增加幅度很小。结论：自澳大利亚引入HAART以来，ADC与其他ADI相比比例增加，确诊时的CD4细胞计数中位数显著增加。这些变化表明，与其他ADI相比，HAART对ADC的影响较小，许多抗逆转录病毒药物对中枢神经系统的渗透性较差可能是原因之一。(C)1999年，Lippincott Williams&Wilkins。
Objectives: To determine the protective efficacy of highly active antiretroviral therapy (HAART) against AIDS dementia complex (ADC) relative to other initial AIDS-defining illnesses (ADIs), Australian AIDS notification data over recent years were examined.Methods: All initial ADIs in Australia over the period 1992-1997 were included. Three initial ADI groups were established: ADC; other predominantly central nervous system (CNS) ADIs (toxoplasmosis and cryptococcosis); and non-CNS ADIs. For each ADI grouping, the proportion of total ADIs, and median CD4 cell count in the pre-HAART era (1992-1995) were compared with the HAART era (1996 and 1997).Results: Initial ADIs peaked in Australia in 1994 (n = 1049), with a gradual decline to 1996 (n = 722), and a marked decline in 1997 (n = 367). ADC constituted 4.4% of initial ADIs over the period 1992-1995, but increased after the introduction of HAART to 6.0% in 1996 and 6.5% in 1997 (P = 0.02). In contrast, the proportion of other CNS ADIs (1992-1995, 8.1%; 1996, 6.0%; 1997, 8.2%; P = 0.41) was stable over the period 1992-1997. The median CD4 cell count at ADC diagnosis increased from 70/mm(3) in 1992-1995 to 120/mm(3) in 1996 and 170/mm(3) in 1997 (P = 0.04). Although the median CD4 cell count also increased significantly over this period for both other CNS ADIs (40-60/mm(3); P = 0.02), and non-CNS ADIs (60-70/mm(3); P = 0.02), the increase was small.Conclusion: A proportional increase in ADC compared with other ADIs and a marked increase in the median CD4 cell count at ADC diagnosis have occurred since the introduction of HAART in Australia. These changes suggest that HAART has a lesser impact on ADC than on other ADIs, with the poor CNS penetration of many antiretroviral agents a possible explanation. (C) 1999 Lippincott Williams & Wilkins.