A PROSPECTIVE-STUDY OF HUMAN IMMUNODEFICIENCY VIRUS TYPE-1 INFECTION AND THE DEVELOPMENT OF AIDS IN SUBJECTS WITH HEMOPHILIA
A PROSPECTIVE-STUDY OF HUMAN IMMUNODEFICIENCY VIRUS TYPE-1 INFECTION AND THE DEVELOPMENT OF AIDS IN SUBJECTS WITH HEMOPHILIA
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DOI：
10.1056/nejm198910263211701
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发表时间：
1989-10-26
影响因子：
158.5
通讯作者：
GAIL, MH
中科院分区：
文献类型：
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作者：
GOEDERT, JJ;KESSLER, CM;GAIL, MH
我们对1219名血友病或相关疾病患者进行了前瞻性多中心队列研究，重点关注319名有记录的血清转化为1型人类免疫缺陷病毒（HIV - 1）日期的患者。血清转化后获得性免疫缺陷综合征（AIDS）的发病率为每100人年2.67例，且与年龄直接相关（1至11岁人群为0.83，35至70岁人群高达5.66；趋势P = 0.00003）。艾滋病的年发病率在血清转化后的第一年为零，到第八年为7%，8年累积发病率（±标准误）在1至17岁为13.3 ± 5.3%，18至34岁为26.8 ± 6.4%，35至70岁为43.7 ± 16.4%。一系列免疫和病毒学标志物（CD4淋巴细胞总数、血清干扰素或HIV - 1 p24抗原的存在，以及抗p24或抗gp120血清水平低或缺失）预示着随后发生艾滋病的高风险。35至70岁的成年人出现低CD4计数的发生率高于较年轻的受试者（P≤0.005），而青少年抗p24缺失率较低（P = 0.0007），1至17岁的受试者在抗p24缺失后艾滋病发病率较低（P = 0.03）。这些发现不仅表明艾滋病的风险与年龄直接相关，还表明老年人在HIV疾病的早期阶段受到的影响尤为严重，青少年可能HIV复制率较低，儿童和青少年可能对严重的免疫缺陷耐受性更好，因为他们其他感染较少，或者由于在HIV疾病后期存在一些未测量的、与年龄相关的辅助因子或免疫改变。
We evaluated a multicenter cohort of 1219 subjects with hemophilia or related disorders prospectively, focusing on 319 subjects with documented dates of seroconversion to human immunodeficiency virus type 1 (HIV-1). The incidence rate of the acquired immunodeficiency syndrome (AIDS) after seroconversion was 2.67 per 100 person-years and was directly related to age (from 0.83 in persons 1 to 11 years old up to 5.66 in persons 35 to 70 years old; Ptrend = 0.00003). The annual incidence of AIDS ranged from zero during the first after seroconversion to 7 percent during the eighth year, with eight-year cumulative rates (.+-. SE) of 13.3 .+-. 5.3 percent for ages 1 to 17, 26.8 .+-. 6.4 percent for ages 18 to 34, and 43.7 .+-. 16.4 percent for ages 35 to 70. Serial immunologic and virologic markers (total numbers of CD4 lymphocytes, presence of serum interferon or HIV-1 p24 antigen, and low or absent serum levels of anti p24 or anti-gp 120) predicted a high risk for the subsequent development of AIDS. Adults 35 to 70 years old had a higher incidence of low CD4 counts than younger subjects (P .ltoreq. 0.005), whereas adolescents had a low rate of anti-p24 loss (P = 0.0007) and subjects 1 to 17 years old had a lower incidence of AIDS after loss of anti-p24(P = 0.03). These findings not only demonstrate that the risk of AIDS is related directly to age but also suggest that older adults are disproportionately affected during the earlier phases of HIV disease, that adolescents may have a low replication rate of HIV, and that children and adolescents may tolerate severe immunodeficiency better because they have fewer other infections or because of some unmeasured, age-dependent cofactor or immune alteration in the later phase of HIV disease.