接受齐多夫定治疗的晚期人类免疫缺陷病毒病患者患卡波西肉瘤的危险因素。齐多夫定流行病学研究组。

Risk factors for Kaposi's sarcoma in patients with advanced human immunodeficiency virus disease treated with zidovudine. Zidovudine Epidemiology Study Group.

作者信息

Gallant J E, Moore R D, Richman D D, Keruly J, Chaisson R E

机构信息

Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md.

出版信息

Arch Intern Med. 1994 Mar 14;154(5):566-72.

PMID:8122950

Abstract

BACKGROUND

Although the cause of Kaposi's sarcoma (KS) is unknown, its unique epidemiology suggests that an infectious, sexually transmitted agent or agents may contribute to its pathogenesis.

METHODS

To assess the natural history of KS associated with the acquired immunodeficiency syndrome and to identify factors associated with its development, data were analyzed from a multicenter, observational cohort study of 1044 persons with the acquired immunodeficiency syndrome or the acquired immunodeficiency syndrome-related complex and a total CD4 cell count of less than 0.25 x 10(9)/L who were treated with zidovudine between April 1987 and April 1988. Records were reviewed bi-monthly. Follow-up continued for 2 years or until death.

RESULTS

One hundred thirty-one patients (13%) had KS a study enrollment, and 143 developed KS (14%) during follow-up, with a 2-year actuarial risk of 21%. The probability of KS at 2 years for patients with initial CD4 cell counts of less than 0.1 x 10(9)/L was 25%, compared with 15% for those with counts of 0.1 x 10(9)/L or more. By logistic regression, a baseline CD4 cell count of less than 0.1 x 10(9)/L (relative odds, 1.43; 95% confidence interval, 1.04 to 1.95), homosexuality (relative odds, 3.71; 95% confidence interval, 1.82 to 7.56), cytomegalovirus disease (relative odds, 1.56; 95% confidence interval, 1.01 to 2.41), and white race (relative odds, 1.64; 95% confidence interval, 1.11 to 2.43) were independently associated with KS. Median survival after KS was 408 days, and KS was an independent predictor of death (relative hazard, 1.78; 95% confidence interval, 1.26 to 2.52).

CONCLUSIONS

Kaposi's sarcoma contributes to human immunodeficiency virus-related morbidity and mortality, especially among male homosexuals. This large cohort study provides further evidence for an association between risk for cytomegalovirus infection and KS.

摘要

背景

尽管卡波西肉瘤（KS）的病因尚不清楚，但其独特的流行病学特征提示一种或多种传染性性传播病原体可能在其发病机制中起作用。

方法

为评估与获得性免疫缺陷综合征相关的KS的自然病史并确定与其发生相关的因素，对一项多中心观察性队列研究的数据进行了分析，该研究纳入了1044例获得性免疫缺陷综合征或与获得性免疫缺陷综合征相关的综合征患者，其总CD4细胞计数低于0.25×10⁹/L，于1987年4月至1988年4月期间接受齐多夫定治疗。每两个月复查一次记录。随访持续2年或直至死亡。

结果

131例患者（13%）在研究入组时患有KS，143例在随访期间发生KS（14%），2年精算风险为21%。初始CD4细胞计数低于0.1×10⁹/L的患者2年时发生KS的概率为25%，而计数为0.1×10⁹/L或更高的患者为15%。通过逻辑回归分析，基线CD4细胞计数低于0.1×10⁹/L（相对比值，1.43；95%置信区间，1.04至1.95）、同性恋（相对比值，3.71；95%置信区间，1.82至7.56）、巨细胞病毒病（相对比值，1.56；95%置信区间，1.01至2.41）和白种人（相对比值，1.64；95%置信区间，1.11至2.43）与KS独立相关。KS后的中位生存期为408天，KS是死亡的独立预测因素（相对风险，1.78；95%置信区间，1.26至2.52）。