Sheppard H W, Ascher M S, Winkelstein W, Vittinghoff E, Osmond D, Moss A R, Shiboski S
Division of Laboratories, California Department of Health Services, Berkeley 94704.
J Acquir Immune Defic Syndr (1988). 1993 Mar;6(3):287-94.
Infection with HIV-1 and < 200 CD4+ lymphocytes/mm3 has been proposed as an AIDS-defining condition. We have evaluated the effects of using this and other T-cell subset measurements, in the diagnosis of AIDS in two cohorts of homosexual/bisexual men in San Francisco. Among 762 HIV-1 infected men, 200 CD4+ lymphocytes/mm3 corresponded to 13 percent CD4+ lymphocytes and a CD4+/CD8+ ratio of 0.23. If these AIDS-defining criteria had been implemented in mid-1991, the number of living AIDS cases would have increased by 106 (212%), 133 (266%), and 136 (272%), respectively. When these criteria were first met, either before or in the absence of a clinical AIDS diagnosis, about half of the subjects were asymptomatic and the median clinically AIDS-free interval was approximately 2 years. Using two consecutive tests or pair-wise combinations of criteria reduced the number of cases identified by testing error or transient biological variation, but the number of living AIDS cases would still be increased more than twofold. Finally, any AIDS case definition using a specific T-cell subset value will be compromised by the inherent variability in these measurements and the substantial overlap in the results for those with and without clinical manifestations of HIV infection.
HIV-1感染且CD4+淋巴细胞计数<200个/mm³已被提议作为艾滋病的定义性疾病。我们评估了使用这一指标及其他T细胞亚群检测方法在旧金山两组同性恋/双性恋男性人群中诊断艾滋病的效果。在762名HIV-1感染男性中，CD4+淋巴细胞计数200个/mm³对应CD4+淋巴细胞占比13%，CD4+/CD8+比值为0.23。如果这些艾滋病定义标准在1991年年中实施，存活的艾滋病病例数将分别增加106例（212%）、133例（266%）和136例（272%）。当首次达到这些标准时，无论在临床诊断艾滋病之前或无临床诊断时，约一半的受试者无症状，临床无艾滋病的中位间隔时间约为2年。使用连续两次检测或标准的两两组合可减少因检测误差或短暂生物学变异而确定的病例数，但存活的艾滋病病例数仍会增加两倍多。最后，任何使用特定T细胞亚群值的艾滋病病例定义都会受到这些检测固有变异性以及HIV感染有临床表现者和无临床表现者结果大量重叠的影响。
