Moore R D, Keruly J, Richman D D, Creagh-Kirk T, Chaisson R E
Department of Medicine, Johns Hopkins University, Baltimore, Maryland.
AIDS. 1992 Jul;6(7):671-7.
To describe the natural history of advanced HIV disease in patients treated with zidovudine.
Longitudinal, observational study.
Twelve academic and community-based sites.
PATIENTS, PARTICIPANTS: Eight hundred and sixty-three patients with AIDS or AIDS-related complex (ARC) with a CD4+ lymphocyte count less than 250 x 10(6)/l, who first received zidovudine between 15 April 1987 and 14 April 1988.
Survival, progression to AIDS and first development of specific opportunistic illness.
Median survival after initiation of zidovudine therapy ranged from greater than 900 days in patients with a baseline CD4+ lymphocyte count greater than or equal to 150 x 10(6)/l to 560 days in patients with a CD4+ lymphocyte count less than 50 x 10(6)/1. Other factors associated significantly with poorer survival were diagnosis of AIDS (versus ARC), baseline age greater than or equal to 40 years, hematocrit less than 35%, and diminished functional status. In patients with ARC at enrollment, median time of progression to AIDS ranged from 810 days in patients with a CD4+ lymphocyte count greater than or equal to 150 x 10(6)/l to 310 days in patients with a CD4+ lymphocyte count less than 50 x 10(6)/l. Rates of development of specific opportunistic infections or neoplasms and HIV encephalopathy were determined for different baseline CD4+ lymphocyte count ranges. Myelosuppression was significantly more common in patients with CD4+ lymphocyte counts greater than or equal to 100 x 10(6)/l. Sixty-five per cent of patients with a CD4+ lymphocyte count greater than or equal to 100 x 10(6)/l and 51% with a CD4+ lymphocyte count less than 100 x 10(6)/l continued to receive zidovudine 2 years after starting therapy.
We describe the natural history of a cohort of patients treated with zidovudine for advanced HIV disease. These CD4+ lymphocyte count-stratified estimates of disease progression should provide prognostic information useful in the clinical management of advanced disease and the design of future studies.
描述接受齐多夫定治疗的晚期艾滋病患者的自然病程。
纵向观察性研究。
12个学术及社区医疗点。
患者、参与者：863例艾滋病或艾滋病相关综合征（ARC）患者，其CD4+淋巴细胞计数低于250×10⁶/L，于1987年4月15日至1988年4月14日首次接受齐多夫定治疗。
生存率、进展为艾滋病以及首次发生特定机会性感染。
开始齐多夫定治疗后的中位生存期，基线CD4+淋巴细胞计数大于或等于150×10⁶/L的患者超过900天，而CD4+淋巴细胞计数低于50×10⁶/L的患者为560天。与较差生存率显著相关的其他因素包括艾滋病诊断（相对于ARC）、基线年龄大于或等于40岁、血细胞比容低于35%以及功能状态下降。入组时为ARC的患者，进展为艾滋病的中位时间，CD4+淋巴细胞计数大于或等于150×10⁶/L的患者为810天，而CD4+淋巴细胞计数低于50×10⁶/L的患者为310天。针对不同基线CD4+淋巴细胞计数范围，确定了特定机会性感染或肿瘤以及HIV脑病的发生率。骨髓抑制在CD4+淋巴细胞计数大于或等于100×10⁶/L的患者中明显更为常见。CD4+淋巴细胞计数大于或等于100×10⁶/L的患者中有65%以及CD4+淋巴细胞计数低于100×10⁶/L的患者中有51%在开始治疗2年后继续接受齐多夫定治疗。
我们描述了一组接受齐多夫定治疗的晚期艾滋病患者的自然病程。这些按CD4+淋巴细胞计数分层的疾病进展估计值应为晚期疾病的临床管理和未来研究设计提供有用的预后信息。
