Bucquet D, Deveau C, Belanger F, Boufassa F, Desmoulins C, Jadand C, Carré N, Leibovici D, Vildé J L, Rouzioux C
INSERM U292, Le Kremlin-Bicêtre.
Presse Med. 1994 Sep 17;23(27):1247-51.
A prospective multicentric epidemiological study (SEROCO) of subjects with a diagnosis of human immunodeficiency virus (HIV) infection was started on January 1, 1988 in order to better understand the natural history of HIV infection and factors related to outcome. Observations after 4 years of follow-up are reported here.
After authorization by the French national ethics committee and the national commission for personal freedom, 18 French centres included non-haemophiliac volunteers who were asymptomatic, had had non anti-HIV treatment and whose HIV positivity had been known less than 1 year at inclusion. These last three criteria were not required for patients whose precise date of contamination was known within a range of +/- 3 months.
On July 15, 1992, there were 1453 infected subjects in the cohort (1063 males, 417 females; age range at inclusion 18-75 years; mean age 31.3 +/- 9.4). Globally, 2.7% of the subjects were symptomatic at inclusion. Mean CD4 lymphocyte count at inclusion was 508/mm3. Clinically, 51.5% of the patients had a history of sexually transmitted disease at inclusion. After 4 years (on July 15, 1992) mean follow-up was 28 +/- 12.9 months for a total of 3428 patient-years. Disease progression to stage IV was observed in 439 patients including 202 who developed the acquired immuno-deficiency syndrome (AIDS). Among these 202 patients, 113 had died at the end-point of this report. The first manifestation of AIDS was Kaposi sarcoma in 44, pulmonary pneumocystosis in 38 and cerebral toxoplasmosis in 27. The probability of developing AIDS was calculated at 13.9% at 5 years, 27.7% at 7 years and 33.7% at 10 years. The probability of a CD4 count below 200/mm3 was 32.7, 55.6 and 67% at 5, 7 and 10 years respectively. For patients with a CD4 count below 200, the probability of developing AIDS was 18% at 1 year, 39% at 2 years and 51% at 3 years.
SEROCO has been a most useful prospective epidemiological tool due to the diversity of the subjects included. The observed natural history of HIV infection will lead to specific research projects aimed at better understanding the disease process.
为了更好地了解人类免疫缺陷病毒（HIV）感染的自然史以及与预后相关的因素，一项针对诊断为HIV感染患者的前瞻性多中心流行病学研究（SEROCO）于1988年1月1日启动。本文报告了4年随访后的观察结果。
经法国国家伦理委员会和国家个人自由委员会批准，18个法国中心纳入了非血友病志愿者，这些志愿者无症状，未接受过抗HIV治疗，且入组时HIV阳性已知时间少于1年。对于那些确切感染日期在±3个月范围内已知的患者，不需要满足最后这三个标准。
1992年7月15日，队列中有1453名感染患者（男性1063名，女性417名；入组时年龄范围为18 - 75岁；平均年龄31.3±9.4岁）。总体而言，2.7%的受试者在入组时有症状。入组时CD4淋巴细胞平均计数为508/mm³。临床上，51.5%的患者在入组时有性传播疾病史。4年后（1992年7月15日），平均随访时间为28±12.9个月，总计3428患者年。439例患者疾病进展至IV期，其中202例发展为获得性免疫缺陷综合征（AIDS）。在这202例患者中，113例在本报告终点时死亡。AIDS的首发表现为卡波西肉瘤44例、肺孢子菌肺炎38例和脑弓形虫病27例。5年时发展为AIDS的概率计算为13.9%，7年时为27.7%，10年时为33.7%。CD4计数低于200/mm³的概率在5年、7年和10年时分别为32.7%、55.6%和67%。对于CD4计数低于200的患者，1年时发展为AIDS的概率为18%，2年时为39%，3年时为51%。
由于纳入对象的多样性，SEROCO一直是一个非常有用的前瞻性流行病学工具。观察到的HIV感染自然史将促成旨在更好理解疾病进程的特定研究项目。
