Deschamps M M, Fitzgerald D W, Pape J W, Johnson W D
Cornell University Medical College, New York, NY, USA.
AIDS. 2000 Nov 10;14(16):2515-21. doi: 10.1097/00002030-200011100-00014.
A study was conducted to define the natural history and disease progression of HIV infection in a developing country.
A prospective longitudinal cohort study.
Forty-two patients with documented dates of HIV seroconversion were followed in Port-au-Prince, Haiti. Patients were seen at 3 month intervals or when ill. Patients were treated for bacterial, mycobacterial, parasitic, and fungal infections, but antiretroviral therapy was not available. Patients were followed until death or until 1 January 2000; median follow-up was 66 months.
By Kaplan-Meier analyses, the median time to symptomatic HIV disease (CDC category B or C) was 3.0 years [95% confidence interval (CI) 2.3-5.0 years]. The median time to AIDS (CDC category C) was 5.2 years (95% CI 4.7-6.5 years), and the median time to death was 7.4 years (95% CI 6.2-10.2 years). Community-acquired infections, including respiratory tract infections, acute diarrhea, and skin infections were common in the pre-AIDS period. AIDS-defining illnesses included tuberculosis, wasting syndrome, cryptosporidiosis, cyclosporiasis, candida esophagitis, toxoplasmosis, and cryptococcal meningitis. Rapid progression to death was associated with anemia at the time of seroconversion hazards ratio (HR) 4.1 (95% CI 1.1-15.0), age greater than 35 years at seroconversion HR 4.4 (95% CI 1.1-16.6), and lymphopenia at seroconversion HR 11.0 (95% CI 2.3-53.0).
This report documents rapid disease progression from HIV seroconversion until death among patients living in a developing country. Interventions, including nutritional support and prophylaxis of common community-acquired infections during the pre-AIDS period may slow disease progression and prolong life for HIV-infected individuals in less-developed countries.
开展一项研究以明确发展中国家HIV感染的自然史和疾病进展情况。
前瞻性纵向队列研究。
在海地太子港对42例有记录的HIV血清转化日期的患者进行随访。患者每3个月就诊一次或在生病时就诊。对患者的细菌、分枝杆菌、寄生虫和真菌感染进行治疗，但无法提供抗逆转录病毒治疗。对患者进行随访直至死亡或直至2000年1月1日；中位随访时间为66个月。
通过Kaplan-Meier分析，出现有症状HIV疾病（美国疾病控制与预防中心B或C类）的中位时间为3.0年[95%置信区间（CI）2.3 - 5.0年]。发展为艾滋病（美国疾病控制与预防中心C类）的中位时间为5.2年（95% CI 4.7 - 6.5年），死亡的中位时间为7.4年（95% CI 6.2 - 10.2年）。社区获得性感染，包括呼吸道感染、急性腹泻和皮肤感染在艾滋病前期很常见。艾滋病界定疾病包括结核病、消瘦综合征、隐孢子虫病、环孢子虫病、念珠菌食管炎、弓形虫病和隐球菌性脑膜炎。血清转化时贫血（风险比[HR] 4.1，95% CI 1.1 - 15.0）、血清转化时年龄大于35岁（HR 4.4, 95% CI 1.1 - 16.6）以及血清转化时淋巴细胞减少（HR 11.0, 95% CI 2.3 - 53.0）与快速进展至死亡相关。
本报告记录了发展中国家患者从HIV血清转化到死亡的快速疾病进展情况。在艾滋病前期进行包括营养支持和预防常见社区获得性感染在内的干预措施，可能会减缓疾病进展并延长欠发达国家HIV感染者的生命。
