Chiesi A, Vella S, Dally L G, Pedersen C, Danner S, Johnson A M, Schwander S, Goebel F D, Glauser M, Antunes F
Instituto Superiore di Sanita, Laboratory of Virology, Rome, Italy.
J Acquir Immune Defic Syndr Hum Retrovirol. 1996 Jan 1;11(1):39-44. doi: 10.1097/00042560-199601010-00005.
The aim of the study was to describe the epidemiology of AIDS dementia complex (ADC) in Europe and to assess the possible role of zidovudine therapy in preventing or delaying its occurrence. We used an inception cohort, with data collected retrospectively from patients' clinical records from 52 clinical centers in 17 countries across Europe. The subjects were 6,548 adult people with AIDS consecutively diagnosed from 1979 to 1989. The main outcome measures were codiagnosis of ADC at the time of AIDS diagnosis and ADC-free time after AIDS diagnosis. ADC was reported in 295 patients (4.5%) at the time of AIDS diagnosis and during follow-up in a further 402 of the 5,160 patients (7.8%) who were diagnosed with AIDS based on diseases other than ADC. Whether at the time of AIDS diagnosis or later, the occurrence of ADC was significantly associated with age, transmission category, and CD4+ cell counts. The risk was greater in older patients (14 and 19% greater, at AIDS diagnosis and after, respectively, for a 5-year difference in age), in i.v. drug users than in homosexual and bisexual men (89 and 60% greater, at AIDS diagnosis and after, respectively), and for people with lower CD4+ cell counts (14 and 30% greater for a reduction of 1 on the natural log scale). Risk was almost double for women than for men. A significant reduction, of approximately 40%, was found in the risk of developing ADC after AIDS diagnosis for patients receiving zidovudine therapy, but this effect was present only during the first 18 months of treatment, irrespective of whether treatment began before or after AIDS diagnosis. In conclusion, an increase in the risk of developing ADC either at the time of AIDS diagnosis or thereafter is associated with increasing age, i.v. drug use, and decreased CD4+ cell count. Women tend to have a higher risk of ADC at the time of AIDS diagnosis. Zidovudine therapy appears to have a definite, but time-limited, effect of protecting patients against ADC development after AIDS diagnosis.
本研究的目的是描述欧洲艾滋病痴呆综合征（ADC）的流行病学特征，并评估齐多夫定治疗在预防或延缓其发生方面的可能作用。我们采用了一个起始队列，数据是从欧洲17个国家52个临床中心的患者临床记录中回顾性收集的。研究对象为1979年至1989年连续确诊的6548例成年艾滋病患者。主要观察指标为艾滋病诊断时ADC的共诊断情况以及艾滋病诊断后的无ADC时间。在艾滋病诊断时，295例患者（4.5%）报告有ADC，在后续随访中，基于除ADC以外的疾病诊断为艾滋病的5160例患者中，又有402例（7.8%）出现ADC。无论在艾滋病诊断时还是之后，ADC的发生均与年龄、传播途径及CD4 + 细胞计数显著相关。老年患者的风险更高（年龄相差5岁时，艾滋病诊断时及之后分别高出14%和19%），静脉吸毒者比同性恋和双性恋男性的风险更高（艾滋病诊断时及之后分别高出89%和60%），CD4 + 细胞计数较低者的风险也更高（自然对数尺度上每降低1，风险分别高出14%和30%）。女性的风险几乎是男性的两倍。接受齐多夫定治疗的患者在艾滋病诊断后发生ADC的风险显著降低约40%，但这种效果仅在治疗的前18个月出现，无论治疗在艾滋病诊断之前还是之后开始。总之，在艾滋病诊断时或之后发生ADC的风险增加与年龄增长、静脉吸毒及CD4 + 细胞计数减少有关。女性在艾滋病诊断时患ADC的风险往往更高。齐多夫定治疗似乎对预防艾滋病诊断后患者发生ADC有明确但有限的作用。
