Hira Subhash K, Shroff H J, Lanjewar D N, Dholkia Y N, Bhatia Vandana P, Dupont H L
AIDS Research and Control Centre (ARCON), Sir J.J. Hospital, Mumbai 400008, Maharashtra, India.
Natl Med J India. 2003 May-Jun;16(3):126-31.
Natural history studies of untreated HIV infection are useful for clinicians, public health experts and policymakers to improve and monitor care, plan services and control, and to model the epidemic. Several natural history studies on homosexual men and intravenous drug users have been published from developed countries. A few studies have emerged on heterosexual populations from Africa. With an emerging epidemic, a similar study was required in India. This study was designed to determine the progression of HIV disease in a prevalent cohort of adult HIV-seropositive patients.
A prevalent cohort of 1009 patients comprising 488 asymptomatic HIV-seropositive persons, 259 with AIDS-related complex (ARC), and 262 with acquired immunodeficiency syndrome (AIDS) were recruited for the study at Sir J.J. Hospital, Mumbai. A case-control study was conducted to determine the correlation of clinical features and other factors with disease progression. Disease progression was determined from the asymptomatic stage to that of ARC and AIDS using time series analysis. The incubation period from HIV to AIDS was also determined, using Weibull curves.
The median incubation periods for progression were: HIV to AIDS-7.9 years and ARC to AIDS--1.9 years. The median survival after developing AIDS was 19.2 months. A comparison of progressors and non-progressors revealed that disease progression correlated with clinical features such as chronic fever (OR 5.6), persistent generalized lymphadenopathy (OR 4.7), persistent cough for >1 month (OR 3.5), chronic diarrhoea (OR 3.3), oral candidiasis (OR 3.2), >10% loss of body weight within 1 month (OR 2.9), incident tuberculosis (OR 2.8) and herpes zoster (OR 2.5). The annual incidence of active clinical tuberculosis was 86/1503 person-years (5.7/ 100 person-years), the median time to occurrence of active tuberculosis was 21.6 months and the annual incidence of mortality was 96/2009 person-years (4.8/100 person-years, 95% CI 3.4, 6.2).
Progression to AIDS and death was faster among the heterosexual cohort in Mumbai than that reported for homosexual men and haemophiliacs in the USA and Europe. Strategies need to be developed to prevent the occurrence of tuberculosis among HIV-infected patients because that would help to reduce the morbidity and mortality. This is the first large study from the Indian subcontinent of a longitudinal follow up of HIV-infected persons. The findings will be useful for advocacy and assessing the impact of antiretroviral therapy (ART) in India.
未经治疗的HIV感染自然史研究对于临床医生、公共卫生专家和政策制定者改善和监测治疗、规划服务与控制措施以及模拟疫情具有重要意义。发达国家已发表了多项关于同性恋男性和静脉吸毒者的自然史研究。非洲也有一些针对异性恋人群的研究。随着疫情的出现，印度也需要进行类似的研究。本研究旨在确定一组成年HIV血清阳性患者中HIV疾病的进展情况。
在孟买的J.J.医院招募了一个由1009名患者组成的现患队列，其中包括488名无症状HIV血清阳性者、259名艾滋病相关综合征（ARC）患者和262名获得性免疫缺陷综合征（AIDS）患者。进行了一项病例对照研究，以确定临床特征和其他因素与疾病进展的相关性。使用时间序列分析确定从无症状阶段到ARC和AIDS阶段的疾病进展。还使用威布尔曲线确定了从HIV感染到AIDS的潜伏期。
进展的中位潜伏期为：HIV感染到AIDS为7.9年，ARC到AIDS为1.9年。患AIDS后的中位生存期为19.2个月。进展者和非进展者的比较显示，疾病进展与慢性发热（OR 5.6）、持续性全身淋巴结肿大（OR 4.7）、持续咳嗽超过1个月（OR 3.5）、慢性腹泻（OR 3.3）、口腔念珠菌病（OR 3.2）、1个月内体重减轻超过10%（OR 2.9）、新发结核病（OR 2.8）和带状疱疹（OR 2.5）等临床特征相关。活动性临床结核病的年发病率为86/1503人年（5.7/100人年），活动性结核病发生的中位时间为21.6个月，年死亡率为96/2009人年（4.8/100人年，95%CI 3.4, 6.2）。
孟买异性恋队列中进展为AIDS和死亡的速度比美国和欧洲报道的同性恋男性和血友病患者更快。需要制定策略来预防HIV感染患者中结核病的发生，因为这将有助于降低发病率和死亡率。这是印度次大陆首次对HIV感染者进行纵向随访的大型研究。这些发现将有助于在印度进行宣传并评估抗逆转录病毒疗法（ART）的影响。
