CLINICAL MANIFESTATIONS AND PREDICTORS OF DISEASE PROGRESSION IN DRUG-USERS WITH HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION
CLINICAL MANIFESTATIONS AND PREDICTORS OF DISEASE PROGRESSION IN DRUG-USERS WITH HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION
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DOI：
10.1056/nejm199212103272401
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发表时间：
1992-12-10
影响因子：
158.5
通讯作者：
FRIEDLAND, GH
中科院分区：
文献类型：
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作者：
SELWYN, PA;ALCABES, P;FRIEDLAND, GH
背景和方法。为了研究注射吸毒者感染人类免疫缺陷病毒 (HIV) 的临床过程，我们对 1985 年 7 月至 1990 年 12 月期间在纽约市接受美沙酮治疗的一组患者进行了前瞻性研究。患者在基线时和此后每半年接受标准化评估，并接受现场初级医疗护理。通过单变量分析检查了获得性免疫缺陷综合症（艾滋病）的进展率以及艾滋病发生前的主要结局；还通过产品极限生存分析和比例风险回归评估了艾滋病风险。结果。在 318 名尚未患有艾滋病的 HIV 血清阳性患者中（171 名男性和 147 名女性），其中 90 名是黑人，179 名是西班牙裔，49 名是白人；中位年龄为33岁。在平均 3.0 年的随访中，55 人（17%）被诊断出患有艾滋病（每 100 人年的发病率为 5.8）。艾滋病发生前的主要结局包括口腔念珠菌病（每100人年发病率11.2）、肺炎和败血症等化脓性细菌感染（8.0）、肺结核（1.2）、多种全身症状（13.6）和带状疱疹（1.3）。共有 41 人死于艾滋病，其中 13 名没有艾滋病的血清反应阳性患者（4.1%）死于细菌感染，而在研究的 411 名血清反应阴性患者中只有 1 人死于细菌感染（P
Background and Methods. To examine the clinical course of human immunodeficiency virus (HIV) infection in injection-drug users, we conducted a prospective study of a cohort of patients in a methadone-treatment program in New York City from July 1985 through December 1990. The patients underwent standardized evaluations at base line and semiannually thereafter and received on-site primary medical care. Rates of progression to the acquired immunodeficiency syndrome (AIDS) and major outcomes before the development of AIDS were examined by univariate analyses; the risk of AIDS was also assessed by product-limit survival analysis and proportional-hazards regression.Results. Of 318 HIV-seropositive patients who did not yet have AIDS (171 men and 147 women), 90 were black, 179 were Hispanic, and 49 were white; the median age was 33 years. Over a median of 3.0 years of follow-up, 55 (17 percent) received a diagnosis of AIDS (incidence per 100 person-years, 5.8). Major outcomes before the development of AIDS included oral candidiasis (incidence per 100 person-years, 11.2), pyogenic bacterial infections including pneumonia and sepsis (8.0), pulmonary tuberculosis (1.2), multiple constitutional symptoms (13.6), and herpes zoster (1.3). There were 41 deaths from AIDS, and 13 seropositive patients without AIDS (4.1 percent) died of bacterial infections, as compared with only 1 of 411 seronegative patients studied (P