Hessol N A, Byers R H, Lifson A R, O'Malley P M, Cannon L, Barnhart J L, Harrison J S, Rutherford G W
AIDS Office, Department of Public Health, City and County of San Francisco, California 94102.
J Acquir Immune Defic Syndr (1988). 1990;3(11):1078-85.
We identified 277 homosexual and bisexual men diagnosed with acquired immune deficiency syndrome (AIDS) whose estimated human immunodeficiency virus (HIV) seroconversion dates, ranging from 1977-85, could be well approximated. These men were from a cohort of 6,705 homosexual and bisexual men originally recruited for studies of sexually transmitted hepatitis B in San Francisco in 1978-80. We compared the time from HIV seroconversion to the initial disease diagnostic of AIDS (AIDS latency period) with the time from first AIDS diagnosis to death (AIDS survival time) and found no significant overall correlation between latency period and survival time. Both Kaplan-Meier and Cox proportional hazard stepwise analyses found the initial AIDS diagnosis to be significantly associated with latency period, with individuals first diagnosed with Kaposi's sarcoma (KS) having a shorter latency but longer survival than those first diagnosed with Pneumocystis carinii pneumonia (PCP) or other AIDS diagnoses. Individuals with KS tended to be diagnosed earlier in the epidemic compared to those with PCP and other non-KS diagnoses. The AIDS survival time was significantly associated with the initial AIDS diagnosis but not with the estimated year of seroconversion, the year of first AIDS diagnosis, age at seroconversion, or racial/ethnic group. The information presented here on the relationship between the AIDS latency period and survival times suggests a model for the pathogenesis of HIV infection in which there is continual deterioration of the immune system. The wider use of antiviral and prophylactic therapies both preceding and following a diagnosis of AIDS may change this model as both latency and survival times are improved.
我们确定了277名被诊断患有获得性免疫缺陷综合征（艾滋病）的同性恋和双性恋男性，他们的人类免疫缺陷病毒（HIV）血清转化日期估计在1977年至1985年之间，且可以得到很好的近似值。这些男性来自于1978年至1980年在旧金山最初招募的6705名同性恋和双性恋男性队列，该队列最初是为研究性传播乙型肝炎而设立的。我们比较了从HIV血清转化到艾滋病初始疾病诊断（艾滋病潜伏期）的时间与从首次艾滋病诊断到死亡（艾滋病存活时间）的时间，发现潜伏期和存活时间之间没有显著的总体相关性。Kaplan-Meier分析和Cox比例风险逐步分析均发现，初始艾滋病诊断与潜伏期显著相关，与首次被诊断患有卡波西肉瘤（KS）的个体相比，首次被诊断患有卡氏肺孢子虫肺炎（PCP）或其他艾滋病诊断的个体潜伏期较短，但存活时间较长。与患有PCP和其他非KS诊断的个体相比，患有KS的个体在疫情中往往更早被诊断出来。艾滋病存活时间与初始艾滋病诊断显著相关，但与估计的血清转化年份、首次艾滋病诊断年份、血清转化时的年龄或种族/族裔群体无关。这里所呈现的关于艾滋病潜伏期和存活时间之间关系的信息提示了一种HIV感染发病机制模型，即免疫系统持续恶化。在艾滋病诊断之前和之后更广泛地使用抗病毒和预防性治疗可能会改变这种模型因为潜伏期和存活时间都会得到改善。
