HIV-1 disease progression and AIDS-defining disorders in rural Uganda
HIV-1 disease progression and AIDS-defining disorders in rural Uganda
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DOI：
10.1016/s0140-6736(97)01474-8
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发表时间：
1997-07-26
期刊：
影响因子：
168.9
通讯作者：
Whitworth, JA
中科院分区：
文献类型：
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作者：
Morgan, D;Maude, GH;Whitworth, JA
大多数HIV-1感染者生活在非洲，但对该大陆疾病的自然史知之甚少。我们研究了生存时间，疾病进展，艾滋病定义的疾病，根据建议的世界卫生组织分期系统，在人口为基础的，农村cohort in Uganda.Methods在1990年，我们招募了一个随机样本的人已经感染HIV-1（作为流行病例）检测过程中的一个普通人群研究的初步调查，形成一个自然史队列。还邀请1990年至1995年期间血清转化的一般人群队列中的个人（事件病例）登记。参加者被视为常规每3个月，当他们生病。结果到1995年底，93例流行病例和86例事件已登记。流行组中有4名患者在初次就诊时处于4期（艾滋病）。在接下来的5年中，37例流行病例进展为艾滋病。7例发病病例进展为艾滋病，血清转换后1年、3年和5年累积进展为艾滋病的比例分别为2%、6%和22%。在进入第1、2和3阶段后的4年内，艾滋病的累积概率分别为11%、33%和58%。在随访期间，流行病例中有47人死亡，事件病例中有7人死亡。患者进入第1、2、3和4期后4年的累积死亡率分别为9%、33%、56%和86%。艾滋病发病后的中位生存期为9.3 months.Interpretation我们的研究结果是重要的优先事项和合理化的治疗资源匮乏的国家。我们发现，同性恋人群的艾滋病进展率与发达国家相似，高于其他传播方式感染的人群。然而，我们发现，与发达国家相比，全因死亡率要高得多，死亡的进展时间要短得多。
Background The majority of people infected with HIV-1 live in Africa, yet little is known about the natural history of the disease in that continent. We studied survival times, disease progression, and AIDS-defining disorders, according to the proposed WHO staging system, in a population-based, rural cohort in Uganda.Methods In 1990 we recruited a random sample of people already infected with HIV-1 (as prevalent cases) detected during the initial survey round of a general-population study to form a natural-history cohort. Individuals from the general-population cohort who seroconverted between 1990 and 1995 (incident cases) were also invited to enrol. Participants were seen routinely every 3 months and when they were ill.Findings By the end of 1995, 93 prevalent cases and 86 incident cases had been enrolled. Four patients in the prevalent group were in stage 4 (AIDS) at the initial visit. During the next 5 years, 37 prevalent cases progressed to AIDS. Seven incident cases progressed to AIDS and the cumulative progression to AIDS at 1, 3, and 5 years after seroconversion was 2%, 6%, and 22%, respectively. The cumulative probability of AIDS at 4 years from entering stages 1, 2, and 3 was 11%, 33%, and 58%, respectively. There were 47 deaths among prevalent cases and seven among incident cases during follow-up. The cumulative mortality 4 years after patients entered stages 1, 2, 3, and 4 was 9%, 33%, 56%, and 86%, respectively. The median survival after the onset of AIDS was 9.3 months.Interpretation Our results are important for the setting of priorities and rationalisation of treatment availability in countries with poor resources. We found that progression rates to AIDS are similar to those in developed countries for homosexual cohorts and greater than for cohorts infected by other modes of transmission. However, we have found that the rates of all-cause mortality are much higher and the progression times to death are shorter than in developed countries.