Rosenberg P S, Goedert J J, Biggar R J
Epidemiologic Methods Section, National Cancer Institute, Rockville, Maryland 20892.
AIDS. 1994 Jun;8(6):803-10. doi: 10.1097/00002030-199406000-00013.
To estimate the age-specific relative risk of progression from HIV seroconversion to onset of AIDS in hemophiliacs and homosexual men.
Prospective follow-up data from HIV seroconversion to AIDS was analyzed for hemophiliacs in the Multicenter Hemophilia Cohort Study and for homosexual men in the International Registry of Seroconverters. Follow-up was censored at 1 July 1987 to obtain natural history estimates unaffected by therapies that were widely used after this date. The age-specific relative hazard of progression was estimated using nonparametric proportional hazards models and the baseline hazard function was described using spline models.
Among the 373 children and adults with hemophilia and the 1020 adult homosexual men, each 10-year increment in age at seroconversion was associated with a 1.6- and 1.4-fold increase in the hazard of progression, respectively. The effect of age was highly significant among hemophiliacs. The magnitude of the effect was consistent in different cohorts of homosexual men, although it was not nominally significant. Furthermore, there was a significant increase (1.9-fold higher) in progression rates among homosexual men above rather than below 35 years of age at seroconversion. After adjusting for age, progression rates among hemophiliacs were significantly slower, possibly because Kaposi's sarcoma was rare. In both groups, the annual hazard rate increased during the first 5 years after seroconversion, but broad confidence limits prevented us from establishing hazard trends beyond this time.
Estimates of the aggregate incubation time distribution were substantially shorter in older compared with younger individuals. The increasing risk with age was similar in hemophiliacs and homosexual men, suggesting that age is an endogenous host factor. These findings can be incorporated into newly developed backcalculation models to estimate HIV infection incidence by age group from age-specific AIDS surveillance data.
评估血友病患者和男同性恋者从HIV血清转化到艾滋病发病的年龄特异性相对风险。
在多中心血友病队列研究中分析了血友病患者从HIV血清转化到艾滋病的前瞻性随访数据，在国际血清转化者登记处分析了男同性恋者的数据。随访于1987年7月1日进行截尾，以获得不受该日期后广泛使用的治疗影响的自然史估计值。使用非参数比例风险模型估计进展的年龄特异性相对风险，并使用样条模型描述基线风险函数。
在373名儿童和成人血友病患者以及1020名成年男同性恋者中，血清转化时年龄每增加10岁，进展风险分别增加1.6倍和1.4倍。年龄对血友病患者的影响非常显著。在不同队列的男同性恋者中，这种影响的程度是一致的，尽管在名义上不显著。此外，血清转化时年龄在35岁以上而非以下的男同性恋者的进展率显著增加（高1.9倍）。调整年龄后，血友病患者的进展率显著较慢，可能是因为卡波西肉瘤罕见。在两组中，血清转化后的前5年年度风险率均增加，但宽泛的置信区间使我们无法确定此后的风险趋势。
与年轻个体相比，老年个体的总体潜伏期分布估计值明显更短。血友病患者和男同性恋者中年龄增长导致的风险增加相似，表明年龄是一个内源性宿主因素。这些发现可纳入新开发的反向推算模型，以根据特定年龄的艾滋病监测数据估计各年龄组的HIV感染发病率。
