Smit Ellen, Skolasky Richard L, Dobs Adrian S, Calhoun Bridget C, Visscher Barbara R, Palella Frank J, Jacobson Lisa P
Department of Social and Preventive Medicine, School of Medicine and Biological Sciences, University at Buffalo, Buffalo, NY 14214-3000, USA.
Am J Epidemiol. 2002 Aug 1;156(3):211-8. doi: 10.1093/aje/kwf039.
The authors examined the impact of potent antiretroviral therapy (ART) on the diagnosis of wasting syndrome in the Multicenter AIDS Cohort Study. Study time was divided into the periods 1988-1990, 1991-1993, 1994-1995, and 1996-1999 to correspond to different treatment eras. The proportion of acquired immunodeficiency syndrome diagnoses in which wasting was present increased from 5% in 1988-1990 to 7.1% in 1991-1993, 7.7% in 1994-1995, and 18.9% in 1996-1999. The incidence of wasting per 1,000 person-years increased from 7.5 in 1988-1990 to 14.4 in 1991-1993 and 22.1 in 1994-1995; it decreased to 13.4 in 1996-1999. Fewer patients with wasting had low hemoglobin and hematocrit levels and reported oral thrush in 1996-1999 than in any other period. Analysis of change in body mass index (weight (kg)/height (m)(2)) after wasting showed a faster return to prewasting levels in 1994-1995 and 1996-1999 than in earlier periods. Case-control analysis showed that wasting prior to 1996 was weakly associated with fatigue (p = 0.10), low hemoglobin (p = 0.11), and CD4-positive T-lymphocyte count (p = 0.04). During 1996-1999, wasting was weakly associated with diarrhea (p = 0.05) and potent ART (p = 0.097). Predictors of wasting have changed with potent ART. Further research is needed to determine whether lipodystrophy may be misdiagnosed as wasting syndrome.
在多中心艾滋病队列研究中，作者们研究了高效抗逆转录病毒疗法（ART）对消瘦综合征诊断的影响。研究时间分为1988 - 1990年、1991 - 1993年、1994 - 1995年和1996 - 1999年这几个时期，以对应不同的治疗时代。伴有消瘦的获得性免疫缺陷综合征诊断比例从1988 - 1990年的5%增至1991 - 1993年的7.1%、1994 - 1995年的7.7%以及1996 - 1999年的18.9%。每1000人年的消瘦发病率从1988 - 1990年的7.5增至1991 - 1993年的14.4以及1994 - 1995年的22.1；在1996 - 1999年降至13.4。与其他任何时期相比，1996 - 1999年消瘦患者中血红蛋白和血细胞比容水平低以及报告有鹅口疮的情况较少。对消瘦后体重指数（体重（千克）/身高（米）²）变化的分析显示，1994 - 1995年和1996 - 1999年比早期更快恢复到消瘦前水平。病例对照分析表明，1996年之前的消瘦与疲劳（p = 0.10）、低血红蛋白（p = 0.11）以及CD4阳性T淋巴细胞计数（p = 0.04）弱相关。在1996 - 1999年期间，消瘦与腹泻（p = 0.05）以及高效ART（p = 0.097）弱相关。消瘦的预测因素已随高效ART而改变。需要进一步研究以确定脂肪代谢障碍是否可能被误诊为消瘦综合征。
