Wagner H U, Kamali A, Nunn A J, Kengeya-Kayondo J F, Mulder D W
Medical Research Council (UK) Research Programme on AIDS in Uganda, Entebbe.
AIDS. 1993 Nov;7(11):1461-7. doi: 10.1097/00002030-199311000-00009.
The AIDS epidemic in sub-Saharan Africa affects whole communities, adding to the already high burden of morbidity. Reports of AIDS cases are usually from hospital attenders, often diagnosed using the World Health Organization (WHO) clinical case definition. Little is known about the extent of HIV-associated morbidity in the general population. The objectives of this study were to describe the prevalence of (1) markers of general morbidity and (2) the criteria of the WHO clinical case definition for AIDS and (3) to determine the association between these markers and HIV-1 serostatus in a rural Ugandan community.
A survey was conducted among the adult population (aged > or = 13 years) of 15 neighbouring villages in Masaka District, south-west Uganda. The survey included medical history, physical examination and testing for HIV-1 antibodies.
The HIV-1 seroprevalence among 4175 out of 5278 (79%) eligible adults was 8.2%. Current health problems were reported by 57.6% of adults, with increased rates in HIV-1-positive subjects, women and older people. Five of the 10 most common complaints showed significant associations with HIV-1 status, as did reported genital ulcer and vaginal discharge. The crude HIV-1 attributable disease burden in the population was 1.2% for current illness, 4.3% for previous serious illness and 9.9% for illness leading to hospital admission. Overall, 11 (3.3%) of the HIV-1-positive and nine (0.2%) of the HIV-1-negative subjects had AIDS as defined by the clinical case definition. The positive and negative predictive values and specificity were 55.0, 92.0%, and 99.8%, respectively.
Against a background of high general morbidity, we observed a relatively small population attribution of HIV-1-associated morbidity. The results indicate that the clinical AIDS case definition may provide a useful tool for population surveys.
撒哈拉以南非洲地区的艾滋病疫情影响着整个社区，使本已很高的发病负担进一步加重。艾滋病病例报告通常来自就医者，往往是根据世界卫生组织（WHO）的临床病例定义确诊的。对于普通人群中与HIV相关的发病情况知之甚少。本研究的目的是描述（1）一般发病标志物的患病率、（2）WHO艾滋病临床病例定义的标准，以及（3）确定乌干达一个农村社区中这些标志物与HIV-1血清学状态之间的关联。
对乌干达西南部马萨卡区15个相邻村庄的成年人群（年龄≥13岁）进行了一项调查。该调查包括病史、体格检查和HIV-1抗体检测。
在5278名符合条件的成年人中，4175人（79%）的HIV-1血清阳性率为8.2%。57.6%的成年人报告了当前的健康问题，HIV-1阳性者、女性和老年人的患病率更高。10种最常见的主诉中有5种与HIV-1状态存在显著关联，报告的生殖器溃疡和阴道分泌物也如此。当前疾病的人群中HIV-1所致的粗疾病负担为1.2%，既往严重疾病为4.3%，导致住院的疾病为9.9%。总体而言，根据临床病例定义，11名（3.3%）HIV-1阳性者和9名（0.2%）HIV-1阴性者患有艾滋病。阳性预测值、阴性预测值和特异性分别为55.0、92.0%和99.8%。
在一般发病率较高的背景下，我们观察到与HIV-1相关的发病率在人群中的归因相对较小。结果表明，临床艾滋病病例定义可能为人群调查提供一个有用的工具。
