Carré N, Deveau C, Belanger F, Boufassa F, Persoz A, Jadand C, Rouzioux C, Delfraissy J F, Bucquet D
Unité INSERM U-292, Hôpital du Kremlin-Bicêtre, France.
AIDS. 1994 Jun;8(6):797-802. doi: 10.1097/00002030-199406000-00012.
To analyse the influence of age at seroconversion and sexual exposure group on the progression of HIV disease.
This multicentre prospective cohort study involved 443 subjects whose date of HIV infection was known to within +/- 1 year. Individuals whose sexual behaviour was exclusively heterosexual after HIV infection constituted the heterosexual group (n = 131). AIDS-free survival was compared with that of men (n = 312) infected through homosexual sex and who continued homosexual activity after HIV infection. They constituted the homosexual group.
The end-point was the onset of an AIDS-defining illness listed in the 1987 revised Centers for Disease Control and Prevention (CDC) criteria. Using the Kaplan-Meier method, AIDS-free survival curves were plotted for three age categories (< 20, 20-39, > or = 40 years). A Cox model was used to quantify the effect of age and to assess the influence of exposure group on AIDS onset after adjustment for age. Because of the high incidence of Kaposi's sarcoma (KS) among homosexual men, a disease that can be an early AIDS-defining illness, multivariate analysis was performed with and without consideration of the occurrence of KS.
Patients aged > or = 40 years at seroconversion progressed more rapidly to AIDS than younger patients (P < 0.006). When age was fitted as a continuous variable and adjusted for exposure group, the relative risk of developing AIDS by any time after seroconversion was 1.34 for a 10-year increase difference [P = 0.03; 95% confidence interval (CI), 1.03-1.77]. After adjustment for age, the relative risk of developing AIDS (CDC criteria) was 2.42 (P = 0.008; 95% CI, 1.18-4.97) among the homosexual men (AIDS cases, n = 56). All cases of KS (n = 19) involved the homosexual group. Excluding KS as a first manifestation of AIDS, homosexual or bisexual subjects had a risk of AIDS of 1.92 (P = 0.07; 95% CI, 0.92-4.03) compared with heterosexual subjects.
The risk of AIDS increases with age at seroconversion. The more rapid progression towards AIDS in the homosexual group than in the heterosexual group persisted after adjustment for age. Further studies are required to determine the possible role of repeated exposure to HIV or other pathogens acquired sexually.
分析血清转化时的年龄及性接触组对HIV疾病进展的影响。
这项多中心前瞻性队列研究纳入了443名已知HIV感染日期在±1年范围内的受试者。HIV感染后性行为仅为异性恋的个体组成异性恋组（n = 131）。将其无艾滋病生存情况与通过同性性行为感染且在HIV感染后仍继续同性活动的男性（n = 312）进行比较。他们组成同性恋组。
终点为1987年修订的美国疾病控制与预防中心（CDC）标准中列出的艾滋病界定疾病的发病。使用Kaplan-Meier方法，为三个年龄类别（<20岁、20 - 39岁、≥40岁）绘制无艾滋病生存曲线。采用Cox模型量化年龄的影响，并在调整年龄后评估接触组对艾滋病发病的影响。由于同性恋男性中卡波西肉瘤（KS）的发病率较高，而KS可能是一种早期艾滋病界定疾病，因此在多因素分析中分别考虑了KS的发生情况和未考虑KS的发生情况。
血清转化时年龄≥40岁的患者比年轻患者进展至艾滋病的速度更快（P < 0.006）。当将年龄作为连续变量纳入并调整接触组后，血清转化后任何时间发生艾滋病的相对风险为，每增加10岁差异为1.34 [P = 0.03；95%置信区间（CI），1.03 - 1.77]。调整年龄后，同性恋男性（艾滋病病例，n = 56）发生艾滋病（CDC标准）的相对风险为2.42（P = 0.008；95% CI，1.18 - 4.97）。所有KS病例（n = 19）均出现在同性恋组。将KS排除在艾滋病的首发表现之外，同性恋或双性恋受试者发生艾滋病的风险为1.92（P = 0.07；95% CI，0.92 - 4.03），而异性恋受试者为1.92。
艾滋病风险随血清转化时的年龄增加而升高。在调整年龄后，同性恋组比异性恋组向艾滋病进展的速度更快这一情况仍然存在。需要进一步研究以确定反复接触HIV或其他性传播病原体可能发挥的作用。
