From the Department of Medicine, Division of Infectious Diseases (Drs Nizami and Holzman) and the Department of Pathology (Dr Rapkiewicz), NYU School of Medicine, New York, New York; CUNY School of Medicine, New York, New York (Ms Morales); and NYU School of Medicine, New York, New York (Ms Hu).
Arch Pathol Lab Med. 2020 May;144(5):572-579. doi: 10.5858/arpa.2019-0144-OA. Epub 2019 Aug 28.
CONTEXT.—: With increasing use and efficacy of antiretroviral therapy for human immunodeficiency virus (HIV) infection, deaths from acquired immunodeficiency syndrome (AIDS)-defining conditions have decreased.
OBJECTIVE.—: To examine trends in the cause of death of HIV-infected patients who underwent autopsy at a major New York City hospital from 1984 to 2016, a period including the major epochs of the AIDS epidemic.
DESIGN.—: Retrospective review of autopsy records and charts with modeling of trends by logistic regression using polynomial models.
RESULTS.—: We identified 252 autopsies in adult patients with AIDS (by 1982 definition) or HIV infection. Prior to widespread use of highly active antiretroviral therapy, in 1984-1995, on average 13 autopsies per year were done. Post-highly active antiretroviral therapy, the average number of autopsies declined to 4.5 per year. The fitted mean age at death was 35 years in 1984 and increased curvilinearly to 46 years (95% CI, 43-49) in 2016 ( < .001). By regression analysis, mean CD4 T-cell count increased from 6 in 1992 to 64 in 2016 ( = .01). The proportion of AIDS-defining opportunistic infections decreased, from 79% in 1984-1987 to 41% in 2008-2011 and 29% in 2012-2016 ( = .04). The frequency of nonopportunistic infections, however, increased from 37% in 1984-1987 to 73% in 2008-2011 and 57% in 2012-2016 ( = .001). The frequency of AIDS-defining and other malignancies did not change significantly during the study period. The prevalence of atherosclerosis at autopsy rose dramatically, from 21% in 1988-1991 to 54% in 2008-2011 ( < .001).
CONCLUSIONS.—: Despite limitations of autopsy studies, many trends in the evolution of the HIV/AIDS epidemic are readily discernable.
随着抗逆转录病毒疗法在人类免疫缺陷病毒（HIV）感染中的应用和疗效不断提高，艾滋病定义性疾病导致的死亡人数已经减少。
研究 1984 年至 2016 年期间在纽约市一家主要医院接受尸检的 HIV 感染者的死因趋势，这一时期包括艾滋病流行的主要阶段。
回顾性尸检记录和图表分析，采用逻辑回归模型和多项式模型进行趋势建模。
我们确定了 252 例 AIDS（按 1982 年定义）或 HIV 感染的成人患者的尸检。在广泛使用高效抗逆转录病毒治疗之前，即 1984-1995 年，平均每年进行 13 例尸检。在高效抗逆转录病毒治疗之后，每年尸检的平均数量下降到 4.5 例。拟合的平均死亡年龄为 1984 年的 35 岁，呈曲线性增加至 2016 年的 46 岁（95%CI，43-49）（<.001）。通过回归分析，平均 CD4 T 细胞计数从 1992 年的 6 增加到 2016 年的 64（=0.01）。艾滋病定义性机会性感染的比例从 1984-1987 年的 79%下降到 2008-2011 年的 41%和 2012-2016 年的 29%（=0.04）。然而，非机会性感染的频率从 1984-1987 年的 37%增加到 2008-2011 年的 73%和 2012-2016 年的 57%（=0.001）。艾滋病定义性和其他恶性肿瘤的发生率在研究期间没有显著变化。尸检中动脉粥样硬化的患病率急剧上升，从 1988-1991 年的 21%上升到 2008-2011 年的 54%（<.001）。
尽管尸检研究存在局限性，但仍很容易发现 HIV/AIDS 流行演变的许多趋势。
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