Graham N M, Park L P, Piantadosi S, Phair J P, Mellors J, Fahey J L, Saah A J
Department of Epidemiology, Johns Hopkins Medical Institutions, Baltimore, Maryland 21205, USA.
Clin Infect Dis. 1995 Feb;20(2):352-62. doi: 10.1093/clinids/20.2.352.
To clarify useful clinical parameters for determining the need for changes in antiretroviral regimens, 586 persons who were seropositive for the human immunodeficiency virus (HIV) and who had intermediate-stage HIV disease underwent follow-up semiannually for a median of 3.1 years after zidovudine monotherapy was instituted. The strongest predictors of time to the development of AIDS and of survival were an increased CD4 lymphocyte count (> 50/microL), a decreased neopterin level (> 2.4 nmol/L), and no increase in the number of symptoms after 7-12 months of zidovudine therapy. Men who had the best quartile CD4 lymphocyte and neopterin responses and who also had no increase in the number of symptoms were 23 times less likely to die (reflecting a 96% increase in survival) than were men who had the worst responses in these variable categories. After 7-12 months of zidovudine therapy, 5-year survival rates were 63% for men with good responses in all three variable categories, 47%-49% for those with good CD4 lymphocyte responses and good responses in one other variable category, 31% for those with only a good CD4 lymphocyte response, and 0 for those with poor responses in all three variable categories.
为了明确用于确定抗逆转录病毒治疗方案是否需要调整的有用临床参数，586名人类免疫缺陷病毒（HIV）血清反应阳性且处于HIV疾病中期的患者在开始齐多夫定单药治疗后，每半年接受一次随访，中位随访时间为3.1年。艾滋病发病时间和生存率的最强预测因素是CD4淋巴细胞计数增加（>50/μL）、新蝶呤水平降低（>2.4 nmol/L）以及齐多夫定治疗7 - 12个月后症状数量未增加。在CD4淋巴细胞和新蝶呤反应处于最佳四分位数且症状数量也未增加的男性中，死亡可能性比在这些变量类别中反应最差的男性低23倍（反映生存率提高96%）。在齐多夫定治疗7 - 12个月后，在所有三个变量类别中反应良好的男性5年生存率为63%，在CD4淋巴细胞反应良好且在另一个变量类别中反应良好的男性为47% - 49%，只有CD4淋巴细胞反应良好的男性为31%，在所有三个变量类别中反应都差的男性为0。
