Poznansky M C, Coker R, Skinner C, Hill A, Bailey S, Whitaker L, Renton A, Weber J
Department of Genitourinary Medicine and Communicable Diseases, St Mary's Hospital Medical School, London.
BMJ. 1995 Jul 15;311(6998):156-8. doi: 10.1136/bmj.311.6998.156.
To study the presentation and survival of patients who present with their first diagnosis of being HIV positive at the same time as their AIDS defining illness.
Retrospective study of patients presenting with AIDS between 1991 and 1993.
Department of genitourinary medicine, St Mary's Hospital, London.
AIDS defining illness at presentation and survival after diagnosis of AIDS.
Between January 1991 and December 1993, 97 out of 436 patients (22%) presented with their first AIDS defining illness coincident with their first positive result of an HIV test (group B). The remaining 339 patients (78%) had tested positive for HIV-1 infection within the previous eight years and had consequently been followed up in clinics before developing their first AIDS defining illness (group A). The two groups of patients did not differ in age and sex distribution, risk factors for HIV-1 infection, nationality, country of origin, or haematological variables determined at the time of the AIDS defining illness. However, the defining illnesses differed between the two groups. Illnesses associated with severe immunodeficiency (the wasting syndrome, cryptosporidiosis, and cytomegalovirus infection) were seen almost exclusively in group A whereas extrapulmonary tuberculosis and Pneumocystis carinii pneumonia were more common in group B. The survival of patients in group B after the onset of AIDS was significantly longer than that of patients in group A as determined by Kaplan-Meier log rank analysis (P = 0.0026).
Subjects who are HIV positive and present late are a challenge to the control of the spread of HIV infection because they progress from asymptomatic HIV infection to AIDS without receiving health care. The finding that presentation with an AIDS defining illness coincident with a positive result in an HIV test did not have a detrimental effect on survival gives insights into the effects of medical intervention on disease progression after a diagnosis of AIDS.
研究首次诊断为HIV阳性同时伴有艾滋病定义疾病的患者的临床表现及生存情况。
对1991年至1993年间出现艾滋病症状的患者进行回顾性研究。
伦敦圣玛丽医院泌尿生殖医学科。
就诊时的艾滋病定义疾病以及艾滋病诊断后的生存情况。
在1991年1月至1993年12月期间，436例患者中有97例（22%）首次出现艾滋病定义疾病时HIV检测结果呈阳性（B组）。其余339例患者（78%）在过去8年内HIV-1感染检测呈阳性，因此在出现首次艾滋病定义疾病之前一直在诊所接受随访（A组）。两组患者在年龄、性别分布、HIV-1感染的危险因素、国籍、原籍国或艾滋病定义疾病发生时所测定的血液学变量方面无差异。然而，两组的定义疾病有所不同。与严重免疫缺陷相关的疾病（消瘦综合征、隐孢子虫病和巨细胞病毒感染）几乎仅见于A组，而肺外结核和卡氏肺孢子虫肺炎在B组更为常见。通过Kaplan-Meier对数秩分析确定，B组患者在艾滋病发病后的生存期明显长于A组患者（P = 0.0026）。
HIV阳性且就诊较晚的患者对控制HIV感染传播构成挑战，因为他们在未接受医疗保健的情况下从无症状HIV感染进展为艾滋病。首次出现艾滋病定义疾病时HIV检测结果呈阳性对生存没有不利影响这一发现，为了解艾滋病诊断后医疗干预对疾病进展的影响提供了见解。
