Solomon P J, Wilson S R
National Centre for Epidemiology and Population Health, Australian National University, Canberra.
Med J Aust. 1992 Jul 20;157(2):121-5.
To describe a method for predicting deaths from, and the prevalence of, the acquired immunodeficiency syndrome (AIDS) in Australia and to obtain ranges of projections for the next five years based on data observed to 30 September 1989 and reported by January 1990. The projections are important components of planning for future health-care needs.
All patients with AIDS in Australia who were known to the National Centre in HIV Epidemiology and Clinical Research. The data used in the analysis were date of diagnosis of AIDS, date of death if the patient had died, and State or Territory of diagnosis.
For Australia as a whole, the doubling time of AIDS incidence changed from 0.83 years before mid 1987 to 4.34 years after that time. Five hundred and seventy patients were diagnosed with AIDS to 30 June 1987 of whom 487 had died by 30 September 1989 and the estimated mean survival time was 1.36 years. Of 1037 patients diagnosed with AIDS after June 1987, 352 had died and the estimated mean survival time was 2.42 years. Combining the estimated survival distribution with the projected new cases of AIDS, we forecast that there will be between 530 and 680 deaths from AIDS in Australia in the year mid 1991 to mid 1992. Estimated cumulative deaths to mid 1994 range from 3390 to 4250. We predict that there will be between 1370 and 1850 people living with AIDS during the year ending mid 1992, and that this number will increase to between 1760 and 2830 for the year ending mid 1994. We also predict that the prevalence of AIDS in New South Wales will lie between 820 and 1620 for the year ending mid 1994, and that the prevalence in Victoria will lie between 270 and 740 in the same year.
Any value in the range of predictions for AIDS incidence we give is equally likely and there is good agreement with the data now observed from mid 1989 to mid 1990. The dramatic increase in the doubling time is the result of a number of factors predicted by epidemic theory and the availability of treatment, zidovudine in particular. Our estimates of deaths and prevalence have been influenced by the quality of the available death data. The observed number of deaths in the year mid 1989 to mid 1990 has exceeded the number forecast for that year. Substantial improvements in survival were associated with the introduction of zidovudine into clinical practice in mid 1987 but the death rate has risen rapidly again in the very recent past, possibly due to patients becoming increasingly refractory to treatment with zidovudine (before or after a diagnosis of AIDS). Our approach to forecasting can be adjusted to accommodate a transient effect of treatment as further data accumulate.
描述一种预测澳大利亚获得性免疫缺陷综合征（艾滋病）死亡人数及患病率的方法，并根据截至1989年9月30日观察到的数据以及1990年1月报告的数据得出未来五年的预测范围。这些预测是规划未来医疗保健需求的重要组成部分。
澳大利亚所有被国家艾滋病流行病学与临床研究中心知晓的艾滋病患者。分析中使用的数据包括艾滋病诊断日期、患者死亡日期（若患者已死亡）以及诊断所在的州或领地。
就澳大利亚整体而言，艾滋病发病率的倍增时间从1987年年中之前的0.83年变为此后的4.34年。到1987年6月30日，有570名患者被诊断为艾滋病，其中487人在1989年9月30日前死亡，估计平均生存时间为1.36年。1987年6月之后被诊断为艾滋病的1037名患者中，352人已死亡，估计平均生存时间为2.42年。将估计的生存分布与预测的艾滋病新病例数相结合，我们预测在1991年年中至1992年年中期间，澳大利亚将有530至680人死于艾滋病。到1994年年中，估计的累积死亡人数在3390至4250人之间。我们预测在截至1992年年中结束的这一年里，将有1370至1850名艾滋病患者存活，到1994年年中结束的这一年，这个数字将增至1760至2830人。我们还预测，在截至1994年年中结束的这一年里，新南威尔士州的艾滋病患病率将在820至1620人之间，同年维多利亚州的患病率将在270至740人之间。
我们给出的艾滋病发病率预测范围内的任何值都同样有可能，并且与1989年年中至1990年年中现在观察到的数据有很好的一致性。倍增时间的急剧增加是由流行病理论预测的一些因素以及治疗方法（特别是齐多夫定）的可用性导致的。我们对死亡人数和患病率的估计受到现有死亡数据质量的影响。1989年年中至1990年年中观察到的死亡人数超过了该年预测的人数。1987年年中齐多夫定引入临床实践后，生存率有了显著提高，但最近死亡率又迅速上升，可能是由于患者对齐多夫定治疗（在艾滋病诊断之前或之后）越来越难以耐受。随着更多数据的积累，我们的预测方法可以进行调整以适应治疗的短暂影响。
