Predictors of the risk of development of acquired immunodeficiency syndrome within 24 months among gay men seropositive for human immunodeficiency virus type 1: a report from the Multicenter AIDS Cohort Study.
Predictors of the risk of development of acquired immunodeficiency syndrome within 24 months among gay men seropositive for human immunodeficiency virus type 1: a report from the Multicenter AIDS Cohort Study.
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人类免疫缺陷病毒 1 型血清阳性的男同性恋者在 24 个月内发生获得性免疫缺陷综合征风险的预测因素：来自多中心艾滋病队列研究的报告。
DOI：
10.1093/oxfordjournals.aje.a116215
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发表时间：
1992
影响因子：
5
通讯作者：
Polk,BF
中科院分区：
文献类型：
--
作者：
Saah,AJ;Muñoz,A;Kuo,V;Fox,R;Kaslow,RA;Phair,JP;RinaldoJr,CR;Detels,R;Polk,BF
人类免疫缺陷病毒1型（HIV-1）感染的自然史的特征是CD 4阳性淋巴细胞的持续下降和获得性免疫缺陷综合征（AIDS）的最终发展。然而，除了CD 4阳性淋巴细胞水平以外的变量有助于测量艾滋病的风险，并可用作艾滋病发病的预测因子。本研究旨在确定独立于CD 4阳性淋巴细胞水平的因素，预测未接受抗逆转录病毒治疗的HIV-1血清阳性同性恋男性队列24个月内患艾滋病的风险。采用单变量和多变量方法分析了多中心AIDS队列研究中1，325例白色HIV-1血清阳性受试者的人口统计学、临床和实验室数据，这些受试者已被研究4年。为了控制感染阶段，使用CD 4阳性淋巴细胞（疾病进展的已知标志物）的基线百分比和观察前6个月期间CD 4阳性细胞的下降作为连续变量。与AIDS发生风险增加独立相关的变量为：基线CD 4百分比低、随访前6个月内CD 4百分比下降、基线时血清免疫球蛋白A存在、随访前6个月内血红蛋白下降、偶发性疲劳以及CD 4百分比下降与偶发性鹅口疮的相互作用。虽然低CD 4百分比和其他变量先前已被描述为预后标志物，但CD 4百分比的下降及其与鹅口疮事件的相互作用先前并未被描述为具有预后重要性。这些变量和估计预后的分析方法可能被证明是有用的选择和评估抗逆转录病毒治疗，制定预防措施，对某些机会性感染，并招募到临床试验。由于研究参与者在分析期间未接受抗逆转录病毒预防，因此该方法可用于估计接受研究性治疗的患者的预后，如果他们未接受治疗，则有效地使临床试验中的任何参与者成为他自己的未治疗对照。
The natural history of infection with human immunodeficiency virus type 1 (HIV-1) is characterized by a relentless decline in CD4-positive lymphocytes and the ultimate development of acquired immunodeficiency syndrome (AIDS). However, variables other than the CD4-positive lymphocyte level contribute to the measurement of risk for AIDS and can be used as predictors of AIDS onset. This study was undertaken to identify factors that, independently of the CD4-positive lymphocyte level, would predict the risk of AIDS over 24 months in a cohort of HIV-1 seropositive homosexual men receiving no antiretroviral therapy. Demographic, clinical, and laboratory data from 1, 325 white, HIV-1 seropositive participants in the Multicenter AIDS Cohort Study who have been studied for 4 years were analyzed with univariate and multivariate methods. To control for stage of infection, the baseline percentage of CD4-positive lymphocytes (a known marker of disease progression), and the decline of CD4-positive cells during the first 6 months of observation were used as continuous variables. The variables that were independently associated with an increased risk of developing AIDS were: low baseline CD4 percentage, decline in the CD4 percentage during the first 6 months of follow-up, the presence of serum immunoglobulin A at baseline, decrease in hemoglobin during the first 6 months of follow-up, incident fatigue, and the interaction of decline in the CD4 percentage and incident thrush. While low CD4 percentage and other variables have been previously described as prognostic markers, decline in the CD4 percentage and the interaction of that decline and incident thrush have not previously been described as being of prognostic importance. These variables and the analytic method for estimating prognosis may prove useful for selecting and evaluating antiretroviral therapy, instituting prophylactic measures against certain opportunistic infections, and recruitment into clinical trials. Because study participants received no antiretroviral prophylaxis during the period under analysis, the method could be used to estimate the prognosis for those receiving investigational treatment were they to remain untreated, effectively making any participant in a clinical trial his own untreated control.Am J Epidemiol1992; 135: 1147–55