Eyster M E, Rabkin C S, Hilgartner M W, Aledort L M, Ragni M V, Sprandio J, White G C, Eichinger S, de Moerloose P, Andes W A
Department of Medicine, Pennsylvania State University School of Medicine, Hershey.
Blood. 1993 Feb 1;81(3):828-34.
To further elucidate the natural history of human immunodeficiency virus (HIV) infection, we studied intermediate HIV-related conditions occurring before acquired immunodeficiency syndrome (AIDS) in a prospectively observed multicenter cohort of 738 HIV-infected persons with hemophilia. We analyzed the frequency in adults and children of common HIV-related conditions and the relative risk of AIDS after occurrence of these conditions, controlling for age at seroconversion and the percentage of CD4+ lymphocytes. Thrombocytopenia was the most frequently observed condition with cumulative incidences of 43% +/- 7% in adults and 27% +/- 6% in children and adolescents by 10 years after seroconversion. Oral candidiasis, fever, weight loss, and non-AIDS pneumonia were two to four times more common in adults than children, whereas herpes zoster risk was similar in the two age groups. HIV-related conditions were infrequent during the first 4 years of infection, particularly in children. With the exception of thrombocytopenia, mean CD4 counts were less than 350 cells/microL at the onset of the conditions. The relative hazard of AIDS after oral candidiasis was 18 in children and 3.8 in adults. Relative hazard in adults was also increased after persistent fever (10), weight loss (3.2), and non-AIDS pneumonia (2.2). Herpes zoster and thrombocytopenia were not significantly associated with AIDS in either age group. We conclude that intermediate HIV-related conditions occur more frequently in adults than in children with hemophilia. Persistent fever is the strongest predictor of AIDS in adults, whereas oral candidiasis is the strongest predictor in children. These findings should facilitate the design and conduct of clinical trials as well as the management of HIV-infected children and adults.
为了进一步阐明人类免疫缺陷病毒（HIV）感染的自然史，我们在一个前瞻性观察的多中心队列中，对738例感染HIV的血友病患者进行了研究，观察在获得性免疫缺陷综合征（AIDS）之前出现的与HIV相关的中间状态。我们分析了常见HIV相关状态在成人和儿童中的发生频率，以及这些状态出现后发生AIDS的相对风险，并对血清转化时的年龄和CD4 +淋巴细胞百分比进行了校正。血小板减少症是最常观察到的状态，血清转化后10年时，成人的累积发病率为43%±7%，儿童和青少年为27%±6%。成人中口腔念珠菌病、发热、体重减轻和非AIDS肺炎的发生率是儿童的两到四倍，而带状疱疹的风险在两个年龄组中相似。在感染的前4年中，与HIV相关的状态很少见，尤其是在儿童中。除血小板减少症外，这些状态出现时的平均CD4计数均低于350个细胞/微升。儿童口腔念珠菌病后发生AIDS的相对风险为18，成人为3.8。成人持续发热（10）、体重减轻（3.2）和非AIDS肺炎（2.2）后发生AIDS的相对风险也增加。带状疱疹和血小板减少症在两个年龄组中均与AIDS无显著相关性。我们得出结论，与HIV相关的中间状态在成人血友病患者中比在儿童中更频繁出现。持续发热是成人AIDS的最强预测因素，而口腔念珠菌病是儿童的最强预测因素。这些发现应有助于临床试验的设计和开展以及对感染HIV的儿童和成人的管理。
