Gallafent James H, Buskin Susan E, De Turk Peter B, Aboulafia David M
University of Washington, School of Medicine, Department of Epidemiology, Seattle, WA, USA.
J Clin Oncol. 2005 Feb 20;23(6):1253-60. doi: 10.1200/JCO.2005.04.156.
Since the advent of highly active antiretroviral therapy (HAART), the incidence of Kaposi's sarcoma (KS) among AIDS patients has declined both nationwide and in King County, Washington. We sought to compare clinical parameters of patients diagnosed with KS in the pre-HAART (1990 to 1996) and HAART (1997 to 2002) eras.
We used patient data abstracted from the Adult/Adolescent Spectrum of HIV-Related Diseases study of Public Health-Seattle and King County.
Patients diagnosed with KS in the HAART era (n = 40) were significantly more likely (P < .05) than pre-HAART-era KS patients (n = 366) to be diagnosed with alcohol problems (43% v 18%), noninjection drug use (45% v 18%), injection drug use (25% v 10%), psychosis (25% v 13%), and hypertension (13% v 2%). Although median CD4(+) count and HIV-1 viral load at the time of KS diagnosis were not significantly different between the two groups, significantly fewer (P < .01) HAART-era KS patients developed opportunistic illnesses (OIs) during their follow-up. The risk of dying among KS patients diagnosed in the HAART era is significantly lower (P < .01) than for KS patients diagnosed in the pre-HAART era (hazard ratio, 0.24).
Although HAART-era KS patients in King County were as likely to have a depleted CD4(+) cell count and high HIV-1 viral loads at the time of KS diagnosis as pre-HAART KS patients, they survived longer and fewer of them were diagnosed with other OIs. They also had an increased prevalence of substance abuse and mental illness, contributing to a dynamic and changing KS clinical profile.
自从高效抗逆转录病毒疗法（HAART）问世以来，美国全国以及华盛顿州金县的艾滋病患者中卡波西肉瘤（KS）的发病率均有所下降。我们试图比较在HAART时代之前（1990年至1996年）和HAART时代（1997年至2002年）被诊断为KS的患者的临床参数。
我们使用了从西雅图和金县公共卫生部门的成人/青少年HIV相关疾病谱研究中提取的患者数据。
在HAART时代被诊断为KS的患者（n = 40）比HAART时代之前被诊断为KS的患者（n = 366）更有可能（P <.05）被诊断出有酒精问题（43%对18%）、非注射吸毒（45%对18%）、注射吸毒（25%对10%）、精神病（25%对13%）和高血压（13%对2%）。尽管两组在KS诊断时的CD4(+)细胞计数中位数和HIV-1病毒载量没有显著差异，但在随访期间，HAART时代的KS患者发生机会性感染（OIs）的人数明显较少（P <.01）。在HAART时代被诊断为KS的患者的死亡风险明显低于HAART时代之前被诊断为KS的患者（P <.01）（风险比，0.24）。
尽管金县HAART时代的KS患者在KS诊断时CD4(+)细胞计数减少和HIV-1病毒载量高的可能性与HAART时代之前的KS患者相同，但他们存活的时间更长，被诊断出患有其他OIs的人数也更少。他们的药物滥用和精神疾病患病率也有所增加，这导致了KS临床特征的动态变化。
