Mientjes G H, van Ameijden E J, van den Hoek A J, Goudsmit J, Miedema F, Coutinho R A
Municipal Health Service, Department of Public Health and Environment, Amsterdam, The Netherlands.
AIDS. 1993 Oct;7(10):1363-70.
To study markers of progression in a cohort of HIV-infected intravenous drug users (IDU).
A prospective epidemiologic study.
We studied progression of HIV infection among 126 IDU attending the Municipal Health Service in Amsterdam.
Progression was defined as a decline of the CD4 cell count to < 200 x 10(6)/l on two consecutive follow-up visits or AIDS.
Using Cox modelling, the following baseline variables were predictive of progression. Enhanced progression was associated with: age > 30 years [relative hazard (RH), 7.7 [95% confidence intervals (CI), 1.7-36.0]], core antibody negativity [RH, 5.3 (95% CI, 1.6-17.6)], CD4 cell count [for CD4 cells 350-500 x 10(6)/l, RH, 1.38 (95% CI, 0.37-5.16); for CD4 cells 200-350 x 10(6)/l, RH, 9.20 (95% CI, 2.73-31.05) compared with a CD4 count > 500 x 10(6)/l]. A lower rate of progression was associated with borrowing used injecting equipment. IDU who reported borrowing injecting equipment between 1980 and baseline 10-99 times or > 99 times had a RH of 0.44 (95% CI, 0.22-0.88) and 0.19 (95% CI, 0.03-0.37), respectively, compared with IDU who had borrowed < 10 times. p24 antigen positivity was more predictive than core antibody negativity in a model with time-dependent variables, the relative risk for p24 antigen-positive participants was 3.5 (95% CI, 1.3-9.3). Additional analysis of progression to AIDS in a larger group of IDU showed comparable results with regard to the effect of borrowing on progression.
Our observation that those IDU who reported borrowing injecting equipment most frequently appeared to have the lowest rate of progression, corrected for some sources of potential confounding, requires further epidemiologic confirmation and extended laboratory studies since other sources of bias might have been present. Baseline CD4 count, age and core antibody or p24 antigen were predictive of progression in IDU. We wish to emphasize that our results do not imply that borrowing should be encouraged, but may have implications for our understanding of HIV pathogenesis.
研究一组感染人类免疫缺陷病毒（HIV）的静脉注射吸毒者（IDU）的病情进展标志物。
一项前瞻性流行病学研究。
我们研究了阿姆斯特丹市卫生服务机构中126名静脉注射吸毒者的HIV感染进展情况。
病情进展定义为在连续两次随访中CD4细胞计数降至<200×10⁶/l或发展为艾滋病。
使用Cox模型，以下基线变量可预测病情进展。病情进展加快与以下因素相关：年龄>30岁[相对危险度（RH），7.7[95%置信区间（CI），1.7 - 36.0]]，核心抗体阴性[RH，5.3（95%CI，1.6 - 17.6）]，CD4细胞计数[对于CD4细胞计数为350 - 500×10⁶/l者，RH，1.38（95%CI，0.37 - 5.16）；对于CD4细胞计数为200 - 350×10⁶/l者，与CD4细胞计数>500×10⁶/l相比，RH，9.20（95%CI，2.73 - 31.05）]。病情进展率较低与借用用过的注射设备有关。报告在1980年至基线期间借用注射设备10 - 99次或>99次的静脉注射吸毒者，与借用次数<10次的静脉注射吸毒者相比，相对危险度分别为0.44（95%CI，0.22 - 0.88）和0.19（95%CI，0.03 - 0.37）。在一个包含时间依赖性变量的模型中，p24抗原阳性比核心抗体阴性更具预测性，p24抗原阳性参与者的相对风险为3.5（95%CI，1.3 - 9.3）。在一大组静脉注射吸毒者中对艾滋病进展情况的进一步分析显示，就借用对病情进展的影响而言，结果相似。
我们观察到那些报告最频繁借用注射设备的静脉注射吸毒者，在校正了一些潜在混杂因素后，病情进展率似乎最低，鉴于可能存在其他偏倚来源，这需要进一步的流行病学证实和扩展的实验室研究。基线CD4计数、年龄以及核心抗体或p24抗原可预测静脉注射吸毒者的病情进展。我们想强调的是，我们的结果并不意味着应该鼓励借用行为，但可能对我们理解HIV发病机制有一定启示。
