Porter K, Fairley C K, Wall P G, Evans B G, Goldberg D J, Weerasuriya M, Noone A
PHLS AIDS Centre, London, UK.
Int J STD AIDS. 1996 Jul;7(4):252-7. doi: 10.1258/0956462961917924.
We examined all reports of adult AIDS cases made to the 2 national surveillance centres in the UK for changes in AIDS defining conditions between January 1982 and September 1994. Differences and changes among persons diagnosed since January 1988 who had and had not been aware of their HIV infection prior to their AIDS diagnosis were of particular interest. Pneumocystis carinii pneumonia (PCP) is the AIDS defining disease most often reported at the initial AIDS diagnosis. Its proportion of all AIDS cases has increased significantly between January 1982 and December 1987 and decreased markedly thereafter. Since January 1988 a significant decrease in the proportion of cases diagnosed with cryptosporidial infection was also observed while increases were observed in the proportion of cases diagnosed with: HIV wasting (chi(1)(2) = 5.56) PML (chi(1)(2) = 19.47), mycobacterium avium complex (chi(1)(2) = 35.76) and pulmonary tuberculosis (chi(1)(2) = 144.0). For cases diagnosed between January 1988 and September 1994, PCP was more likely to be diagnosed in patients previously unaware of their HIV infection (P < 0.01) as was extrapulmonary TB (P < 0.01). In contrast, the following diseases were more likely to be diagnosed in patients already aware of their HIV infection prior to the diagnosis of AIDS: oesophageal candidiasis (P < 0.001), HIV wasting (P = 0.07), mycobacterium avium complex (P = 0.0001), cytomegalovirus disease (P < 0.001), HIV encephalopathy (P = 0.0009) and cryptosporidial infection (P = 0.02). Prophylaxis and anti-retroviral therapy appear to have had a significant impact on the temporal changes of the most frequently diagnosed AIDS diseases. While PCP prophylaxis has substantially reduced the likelihood of a PCP diagnosis at AIDS, the corresponding increase in other opportunistic infections suggests that there may be a need for improved prophylaxis for these conditions.
我们审查了向英国两个国家监测中心报告的所有成人艾滋病病例，以了解1982年1月至1994年9月期间艾滋病定义疾病的变化情况。1988年1月以来确诊的病例中，在艾滋病诊断之前已知和未知感染艾滋病毒的人群之间的差异和变化尤其令人关注。卡氏肺孢子虫肺炎（PCP）是最初艾滋病诊断时最常报告的艾滋病定义疾病。在1982年1月至1987年12月期间，其在所有艾滋病病例中的比例显著增加，此后显著下降。自1988年1月以来，隐孢子虫感染确诊病例的比例也显著下降，而确诊为以下疾病的病例比例有所增加：艾滋病毒消瘦（χ(1)(2)=5.56）、进行性多灶性白质脑病（χ(1)(2)=19.47）、鸟分枝杆菌复合体（χ(1)(2)=35.76）和肺结核（χ(1)(2)=144.0）。对于1988年1月至1994年9月期间确诊的病例，与肺外结核一样，PCP更有可能在先前未知感染艾滋病毒的患者中被诊断出来（P<0.01）。相比之下，以下疾病更有可能在艾滋病诊断之前已知感染艾滋病毒的患者中被诊断出来：食管念珠菌病（P<0.001）、艾滋病毒消瘦（P=0.07）、鸟分枝杆菌复合体（P=0.0001）、巨细胞病毒病（P<0.001）、艾滋病毒脑病（P=0.0009）和隐孢子虫感染（P=0.02）。预防和抗逆转录病毒疗法似乎对最常诊断的艾滋病疾病的时间变化产生了重大影响。虽然PCP预防措施大幅降低了艾滋病诊断时PCP诊断的可能性，但其他机会性感染的相应增加表明，可能需要改进对这些疾病的预防措施。
