Hessol N A, Koblin B A, van Griensven G J, Bacchetti P, Liu J Y, Stevens C E, Coutinho R A, Buchbinder S P, Katz M H
AIDS Office, Department of Public Health, San Francisco, CA.
Am J Epidemiol. 1994 Jun 1;139(11):1077-87. doi: 10.1093/oxfordjournals.aje.a116951.
The authors evaluated the progression of human immunodeficiency virus type 1 (HIV-1) disease from the date of seroconversion to the development of acquired immunodeficiency syndrome (AIDS) and death among 362 well-documented seroconverters. The participants were homosexual men in hepatitis B vaccine trials in Amsterdam (n = 74), New York City (n = 120), and San Francisco (n = 168). There were significant differences in the proportion of deaths, mean age at seroconversion, and mean age at AIDS diagnosis in the three cohorts, but no significant differences in the reported use of zidovudine and Pneumocystis carinii pneumonia prophylaxis. Overall progression rates did not differ significantly across the cohorts: the median time to the development of AIDS was 122 months, and the median time from the initial AIDS diagnosis to death was 20 months. Multivariate proportional hazards analysis of progression from HIV-1 seroconversion to the development of AIDS found faster progression after June 1989. Multivariate proportional hazards analysis of progression from AIDS to death found younger age at diagnosis, an initial diagnosis of Kaposi's sarcoma, and more recent calendar time to be associated with slower progression. Multivariate proportional hazards analysis of progression from HIV-1 seroconversion to death found older age at seroconversion to be associated with faster progression. The 1987 expansion of the AIDS case definition, improved diagnostic methods, and more conscientious care-seeking behaviors may have resulted in diagnosis of AIDS at an earlier stage of HIV-1 infection, which would shorten the apparent time from seroconversion to progression to AIDS. This would also tend to increase survival after an initial AIDS diagnosis, which was observed in the more recent calendar periods, although such increases could also result from improved treatments and prophylaxis for HIV-1 disease. The time from seroconversion to death, a period not influenced by variations in diagnosing AIDS, lengthened only slightly in recent years.
作者评估了362例有充分记录的血清转化者从血清转化之日起至获得性免疫缺陷综合征（AIDS）发生及死亡时人类免疫缺陷病毒1型（HIV-1）疾病的进展情况。参与者为阿姆斯特丹（n = 74）、纽约市（n = 120）和旧金山（n = 168）乙肝疫苗试验中的同性恋男性。三个队列在死亡率、血清转化时的平均年龄以及AIDS诊断时的平均年龄方面存在显著差异，但在齐多夫定的使用情况和卡氏肺孢子虫肺炎预防措施的报告方面无显著差异。各队列的总体进展率无显著差异：发展为AIDS的中位时间为122个月，从首次AIDS诊断到死亡的中位时间为20个月。对从HIV-1血清转化到AIDS发展的进展进行多变量比例风险分析发现，1989年6月后进展更快。对从AIDS到死亡的进展进行多变量比例风险分析发现，诊断时年龄较小、最初诊断为卡波西肉瘤以及更近的日历时间与进展较慢相关。对从HIV-1血清转化到死亡的进展进行多变量比例风险分析发现，血清转化时年龄较大与进展较快相关。1987年AIDS病例定义的扩展、诊断方法的改进以及更自觉的就医行为可能导致在HIV-1感染的更早阶段诊断出AIDS，这会缩短从血清转化到进展为AIDS的表观时间。这也往往会增加首次AIDS诊断后的生存率，在最近的日历时间段中观察到了这种情况，尽管这种增加也可能源于对HIV-1疾病治疗和预防的改善。从血清转化到死亡的时间不受AIDS诊断差异的影响，近年来仅略有延长。
