Has the rate of progression to AIDS changed in recent years?
Has the rate of progression to AIDS changed in recent years?
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DOI：
10.1097/00002030-199713000-00010
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发表时间：
1997-11-01
期刊：
影响因子：
3.8
通讯作者：
vandenHoek, A
中科院分区：
文献类型：
--
作者：
Carre, N;Prins, M;vandenHoek, A
目的：通过测试血清转化年份对艾滋病发病的影响（疾病控制和预防中心 1987 年修订的分类）以及随访日历期的影响，调查艾滋病进展率是否随着时间的推移而变化。设计：法国多中心前瞻性研究，对 385 名同性恋和异性恋受试者以及来自欧洲注射吸毒者 (IDU) 多中心研究的 231 名受试者进行，所有受试者都有 HIV-1 感染记录方法：通过对数秩检验比较血清转换年份的效果。使用 Cox 模型对粗略和调整后相对风险 (ARH) 进行量化。分别对性接触组和注射吸毒者的随访日历周期进行了研究，并在 Cox 模型中将其视为时间依赖性变量。 结果：在 616 名研究对象中，血清转化年份与 AIDS 发生没有显着相关 (n = 108)：对于那些在1988-1989 年，与 1988 年之前发生血清转化的患者相比，1989 年之后发生血清转化的患者为 1.17（95% CI，0.61-2.25）。在性接触组中，在 1991-1992 年随访的受试者中观察到明显的趋势，表明艾滋病进展速度较慢（ARH，0.49；95% CI， 0.24-0.99）和 1992 年之后（ARH，0.54；95% CI；0.24-1.21），与 1991 年之前相比。尽管作为 AIDS 定义疾病的卡氏肺孢子虫肺炎随着时间的推移显着减少，但在 IDU 中并未观察到这种有利趋势。与性接触组相反，在 IDU 的最近一个日历周期内，当 CD4 coint 阈值达到 200 x 10(6)/l 时，抗逆转录病毒治疗（主要是齐多夫定）处方的频率仍然较低。结论：没有发现证据表明近年来血清转化的受试者进展为 AIDS 的比率发生变化。此外，与性接触群体相反，近年来注射毒品使用者缺乏有利趋势，这表明医疗保健系统并不总是适应他们的生活方式。
Objectives: To investigate whether the rate of progression to AIDS has changed over lime by testing an effect of the year of seroconversion on AIDS onset (Centers for Disease Control and Prevention 1987 revised classification), next to an effect of the calendar period of follow-up.Design: French multicentre prospective study of 385 homosexual and heterosexual subjects and 231 subjects from a multicentre study of European injecting drug users (IDU), all with a documented dale of HIV-1 seroconversion.Method: The effect of the year of seroconversion was compared by the log-rank test. Crude and adjusted relative hazard (ARH) were quantified using the Cox model. Calendar period of follow-up was studied separately for sexual exposure group and IDU and treated as a rime-dependent variable in a Cox model.Results: In the 616 study subjects the year of seroconversion was not significantly related re AIDS occurrence (n = 108): the ARH was 0.88 [95% confidence interval (CI), 0.56-1.38] for those who seroconverted in 1988-1989, and 1.17 (95% CI, 0.61-2.25) for those who seroconverted after 1989, compared with those who seroconverted before 1988. In the sexual exposure group, a clear trend rewards less rapid progression to AIDS was observed in subjects followed in 1991-1992 (ARH, 0.49; 95% CI, 0.24-0.99) and after 1992 (ARH, 0.54; 95% CI; 0.24-1.21), compared with those followed before 1991. This favorable trend was not observed in IDU despite a significant decrease over time of Pneumocystis carinii pneumonia as AIDS-defining illness. Conversely to sexual exposure groups, the frequency of antiretroviral treatment (mainly zidovudine) prescription was still low during the most recent calendar periods in IDU when the CD4 co-int threshold of 200 x 10(6)/l was reached.Conclusions: No evidence was found of a change in the rate of progression to AIDS in subjects who seroconverted in recent years. Furthermore, conversely to sexual exposure groups, the lack of favorable trends in IDU users followed in recent years suggest that health-care systems are not always adapted to their lifestyles.