Factors associated with survival following secondary AIDS: 1988 to 1995.
Factors associated with survival following secondary AIDS: 1988 to 1995.
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与继发性艾滋病后生存相关的因素：1988 年至 1995 年。
DOI：
10.1097/00042560-199808150-00012
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发表时间：
1998
期刊：
影响因子：
--
通讯作者：
Muñoz,A
中科院分区：
文献类型：
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作者：
Huang,H;Chmiel,JS;Detels,R;Hoover,DR;Muñoz,A
：按时间顺序诊断的第二种艾滋病定义疾病在本报告中称为第二次艾滋病诊断。在这项研究中，我们使用在二次艾滋病诊断前一年内已知的人口学和临床因素来检查二次艾滋病诊断后的存活率。在多中心艾滋病队列研究(MACS)观察的2412名HIV血清阳性同性恋男性的前瞻性队列中，609人在1988年1月1日至1995年3月31日期间被诊断为艾滋病。为了分析数据，我们使用了生存分析方法，包括Kaplan-Meier乘积极限估计器和允许非比例风险的扩展Cox模型。二次诊断后的中位生存期为10.3个月。从最初的艾滋病诊断进展到第二次诊断的速度与生存无关。1995年以前的药物治疗由于适应症的混淆(即选择偏差)和对晚期疾病的疗效有限而没有显示出有益的效果。然而，通过使用日历周期作为相对药物治疗暴露的替代衡量标准，获得了有益的效果。二次诊断的日历年较晚，继发性卡波西肉瘤和较高的CD4+细胞计数被发现显著(p<；05)与较长的生存时间相关。然而，二次艾滋病诊断只在短期内是一个重要因素。以继发性卡氏肺孢子虫肺炎为参照，卡波西肉瘤继发诊断后3个月死亡的相对危险度为0.56(95%可信区间=0.36~0.89)，同时诊断多种继发疾病后死亡的相对危险度为2.06(95%CI=1.26~3.38)。在二次诊断后大约一年后，诊断类型不再与生存显著相关。
: The second AIDS-defining condition diagnosed chronologically is referred to in this report as the secondary AIDS diagnosis. In this study, we examined survival following a secondary AIDS diagnosis using demographic and clinical factors known within 1 year before secondary AIDS diagnosis. In a prospective cohort of 2412 HIV-seropositive homosexual men observed in the Multicenter AIDS Cohort Study (MACS), 609 presented with a secondary AIDS diagnosis between January 1, 1988 and March 31, 1995. To analyze the data, we used survival analysis methods including the Kaplan-Meier product-limit estimator and extended Cox models that allow for nonproportional hazards. The median survival time after a secondary diagnosis was 10.3 months. Rapidity of progression from an initial AIDS diagnosis to a secondary diagnosis was not associated with survival. Drug treatment did not show a beneficial effect because of confounding by indication (ie, selection bias) and limited efficacy on advanced disease of treatments available prior to 1995. However, a beneficial effect was captured by the use of calendar periods as a proxy measure for the relative exposure to drug treatments. Later calendar year of secondary diagnosis, secondary Kaposi's sarcoma, and higher CD4+ cell count were found to be significantly (p<. 05) associated with longer survival time. However, secondary AIDS diagnosis was a significant factor only in the short term. Using secondary Pneumocystis carinii pneumonia as the reference diagnosis, the relative hazard of death 3 months after the time of secondary Kaposi's sarcoma diagnosis was 0.56 (95% confidence interval [CI]= 0.36-0.89) whereas the relative hazard after concurrently diagnosed multiple secondary illnesses was 2.06 (95% CI= 1.26-3.38). After approximately 1 year from the secondary diagnosis, the type of diagnosis was no longer significantly associated with survival.