Palenicek J, Nelson K E, Vlahov D, Galai N, Cohn S, Saah A J
Department of Epidemiology, Johns Hopkins School of Hygiene and Public Health, Md.
Arch Intern Med. 1993 Aug 9;153(15):1806-12.
To compare the prevalence of human immunodeficiency virus (HIV)-related clinical symptoms among male intravenous drug users and homosexual men stratified by HIV serostatus and CD4 cell levels.
A cross-sectional sample using concurrent longitudinal studies of the natural history of HIV-1 infection among intravenous drug users (N = 539) and homosexual men (N = 932) was recruited in Baltimore, Md. Participants were administered a risk behavior interview and physical examination, and had hematologic tests evaluated in a similar calendar period.
Both risk groups demonstrated an inverse relationship between frequency of symptoms and CD4 cell count. Fever, night sweats, and lymphadenopathy were not evaluated because pilot data suggested a confounding association with drug injection. Among those with mild to moderate immune suppression, intravenous drug users were significantly more likely than homosexual men to experience fatigue, weight loss, diarrhea, and shortness of breath; to have oral candidiasis, palpable spleen, and lower mean weight on physical examination; and abnormal hematocrit, platelets, and total lymphocyte counts. However, participants in either risk group with CD4 cell levels below 0.2 x 10(9)/L experienced similar frequency of all clinical symptoms. Self-reported oral candidiasis increased fourfold with HIV infection and was as likely in both groups at all CD4 cell levels. Duration and recency of intravenous drug use was not significantly associated with the higher frequency of most clinical symptoms.
Social factors are an important consideration in evaluating the association between clinical symptoms and HIV immunosuppression. Except for oral candidiasis, there are limitations for the use of clinical symptoms as intermediate outcome measures for HIV infection among intravenous drug users.
比较按人类免疫缺陷病毒（HIV）血清学状态和CD4细胞水平分层的男性静脉吸毒者和男同性恋者中与HIV相关临床症状的患病率。
在马里兰州巴尔的摩招募了一个横断面样本，采用对静脉吸毒者（N = 539）和男同性恋者（N = 932）中HIV-1感染自然史的同期纵向研究。参与者接受了风险行为访谈和体格检查，并在相似的日历时间段内进行了血液学检查评估。
两个风险组均显示症状频率与CD4细胞计数呈负相关。由于初步数据表明与药物注射存在混杂关联，因此未对发热、盗汗和淋巴结病进行评估。在轻度至中度免疫抑制者中，静脉吸毒者比男同性恋者更易出现疲劳、体重减轻、腹泻和呼吸急促；体格检查时更易出现口腔念珠菌病、可触及脾脏和平均体重较低；以及血细胞比容、血小板和总淋巴细胞计数异常。然而，CD4细胞水平低于0.2×10⁹/L的任一风险组参与者所有临床症状的发生频率相似。自我报告的口腔念珠菌病在HIV感染时增加了四倍，且在所有CD4细胞水平的两组中发生率相同。静脉吸毒的持续时间和近期情况与大多数临床症状的较高发生率无显著关联。
社会因素是评估临床症状与HIV免疫抑制之间关联时的重要考虑因素。除口腔念珠菌病外，将临床症状用作静脉吸毒者中HIV感染的中间结局指标存在局限性。
