DECLINING INCIDENCE OF AIDS DEMENTIA COMPLEX AFTER INTRODUCTION OF ZIDOVUDINE TREATMENT
DECLINING INCIDENCE OF AIDS DEMENTIA COMPLEX AFTER INTRODUCTION OF ZIDOVUDINE TREATMENT
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DOI：
10.1136/bmj.299.6703.819
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发表时间：
1989-09-30
影响因子：
105.7
通讯作者：
GOUDSMIT, J
中科院分区：
文献类型：
--
作者：
PORTEGIES, P;DEGANS, J;GOUDSMIT, J
目的是评估艾滋病痴呆综合征的发病率和脑脊液中HIV I p24抗原的存在与齐多夫定治疗的关系。对1982 ~ 1988年连续系列艾滋病患者的回顾性研究。从1982年到1988年检查了196例有神经系统症状的艾滋病患者。他们接受齐多夫定治疗，齐多夫定于1987年5月1日引入荷兰，用于治疗有严重HIV感染症状的患者（疾病控制中心IVA、B、C和D组）。主要结果是诊断艾滋病痴呆综合征和脑脊液中存在HIV I p24抗原。196例艾滋病患者中有40例（20%）被诊断为艾滋病痴呆综合征。107例未服用齐多夫定的艾滋病患者中有38例（36%）出现了艾滋病痴呆综合征，而服用齐多夫定的89例患者中有2例（2%）出现了艾滋病痴呆综合征（p < 0.00001）。1987年5月开始使用齐多夫定后，艾滋病痴呆综合症的发病率在1987年上半年上升到53%，1987年下半年下降到10%，1988年下降到3%。根据DSM-III标准，在艾滋病痴呆综合征（1986年）定义之前诊断痴呆，1986年前后诊断之间有很好的一致性。未服用齐多夫定的61例艾滋病患者（10例患有艾滋病痴呆综合征）的脑脊液样本中有16例（26%）HIV I p24抗原阳性，而服用齐多夫定的37例艾滋病患者（2例患有艾滋病痴呆综合征）的脑脊液样本中无一例阳性。在采用齐多夫定系统治疗后，艾滋病患者中艾滋病痴呆综合征的发生率下降;艾滋病痴呆综合征可能通过抑制中枢神经系统中的病毒复制来预防。
The objective was to assess the incidence of the AIDS dementia complex and the presence of HIV I p24 antigen in cerebrospinal fluid in relation to zidovudine treatment. A retrospective study of a consecutive series of patients with AIDS from 1982 to 1988. 196 patients with AIDS and neurological symptoms examined from 1982 to 1988. They were treated with zidovudine, which was introduced to The Netherlands on 1 May 1987 for patients with severe symptoms of HIV infection (Centers for Disease Control groups IVA, B, C, and D). The main outcome was the diagnosis of AIDS dementia complex and presence of HIV I p24 antigen in cerebrospinal fluid. The AIDS dementia complex was diagnosed in 40 of the 196 (20%) patients with AIDS. Thirty eight of 107 patients with AIDS (36%) not taking zidovudine developed the AIDS dementia complex compared with two of the 89 (2%) taking the drup (p < 0.00001). The incidence of the AIDS dementia complex increased to 53% in the first half of 1987, after the introduction of zidovudine in May 1987, decreasing to 10% in the second half of 1987 and to 3% in 1988. Dementia was diagnosed before definition of the AIDS dementia complex (1986) according to DSM-III criteria and there was good agreement between diagnosis before and after 1986. Sixteen of 61 samples of cerebrospinal fluid (26%) from patients with AIDS (10 with the AIDS dementia complex) not taking zidovudine were positive for HIV I p24 antigen, whereas none of 37 cerebrospinal fluid samples from patients with AIDS (two with the AIDS dementia complex) taking zidovudine were positive. The incidence of AIDS dementia complex in patients with AIDS declined after the introduction of systematic treatment with zidovudine; the AIDS dementia complex might be prevented by inhibiting viral replication in the central nervous system.