Castelnuovo B, Chiesa E, Rusconi S, Adorni F, Bongiovanni M, Melzi S, Cicconi P, Tordato F, Meroni L, Bini T, d'Arminio Monforte A
Institute of Infectious Diseases and Tropical Medicine, University of Milan, Via G.B. Grassi 74, 20157 Milan, Italy.
Eur J Clin Microbiol Infect Dis. 2003 Nov;22(11):663-9. doi: 10.1007/s10096-003-1038-8. Epub 2003 Oct 21.
Presented here are the results of a cohort study conducted on 3,483 consecutive HIV/AIDS patients between January 1993 and December 2000 to determine trends in AIDS incidence and presentation. The incidence of AIDS was calculated in the general population and examined further according to gender, age (< or = or >49 years), and heterosexual behaviour as a risk factor for HIV. Multivariate analysis was used to identify variables associated with AIDS presenters (defined as patients diagnosed with AIDS within 1 month of the first HIV-positive test). The numbers of patients with AIDS classified as (i) AIDS presenters, (ii) known HIV-positive patients on antiretroviral treatment, and (iii) known HIV-positive patients not receiving antiretroviral treatment were calculated. The overall incidence of AIDS decreased over time, mainly due to the lower number of patients on antiretroviral treatment developing AIDS. Factors associated with a higher risk of being an AIDS presenter were male gender and year of HIV diagnosis. Among patients with AIDS, the proportion of AIDS presenters increased from 13.8% prior to 1997 (when protease inhibitors were introduced in Italy) to 32.5% after 1997. Variables predictive of being an AIDS presenter were male gender, age at diagnosis, and AIDS diagnosis in the years 1997-2000. Heterosexuals had a higher risk of being AIDS presenters and a lower risk of being HIV-positive and not receiving antiretroviral treatment than intravenous drug users. In Italy, AIDS occurs mainly in subjects unaware of their HIV status (especially males, the elderly, and those infected heterosexually) or in patients refusing antiretroviral therapy (mainly intravenous drug users who do not refer to specialised centres).
本文呈现了一项队列研究的结果，该研究针对1993年1月至2000年12月期间连续收治的3483例艾滋病毒/艾滋病患者展开，旨在确定艾滋病的发病率及临床表现趋势。在普通人群中计算艾滋病发病率，并根据性别、年龄（≤49岁或＞49岁）以及作为艾滋病毒危险因素的异性性行为作进一步分析。采用多变量分析来确定与艾滋病确诊者（定义为在首次艾滋病毒检测呈阳性后1个月内被诊断为艾滋病的患者）相关的变量。计算了被分类为（i）艾滋病确诊者、（ii）接受抗逆转录病毒治疗的已知艾滋病毒阳性患者、（iii）未接受抗逆转录病毒治疗的已知艾滋病毒阳性患者的人数。随着时间推移，艾滋病的总体发病率有所下降，这主要归因于接受抗逆转录病毒治疗的患者中患艾滋病的人数减少。与成为艾滋病确诊者风险较高相关的因素为男性性别及艾滋病毒诊断年份。在艾滋病患者中，艾滋病确诊者的比例从1997年之前（意大利引入蛋白酶抑制剂时）的13.8%增至1997年之后的32.5%。预测成为艾滋病确诊者的变量为男性性别、诊断时的年龄以及1997 - 2000年期间的艾滋病诊断情况。与静脉吸毒者相比，异性恋者成为艾滋病确诊者的风险较高，而成为艾滋病毒阳性且未接受抗逆转录病毒治疗者的风险较低。在意大利，艾滋病主要发生在未意识到自身艾滋病毒感染状况的人群（尤其是男性、老年人以及异性感染人群）或拒绝接受抗逆转录病毒治疗的患者（主要是未前往专科中心就诊的静脉吸毒者）中。
