Morgan D, Maude G H, Malamba S S, Okongo M J, Wagner H U, Mulder D W, Whitworth J A
Medical Research Council Programme on AIDS, Uganda Virus Research Institute, Entebbe, Uganda.
Lancet. 1997 Jul 26;350(9073):245-50. doi: 10.1016/S0140-6736(97)01474-8.
The majority of people infected with HIV-1 live in Africa, yet little is known about the natural history of the disease in that continent. We studied survival times, disease progression, and AIDS-defining disorders, according to the proposed WHO staging system, in a population-based, rural cohort in Uganda.
In 1990 we recruited a random sample of people already infected with HIV-1 (as prevalent cases) detected during the initial survey round of a general-population study to form a natural-history cohort. Individuals from the general-population cohort who seroconverted between 1990 and 1995 (incident cases) were also invited to enroll. Participants were seen routinely every 3 months and when they were III.
By the end of 1995, 93 prevalent cases and 86 incident cases had been enrolled. Four patients in the prevalent group were in stage 4 (AIDS) at the initial visit. During the next 5 years, 37 prevalent cases progressed to AIDS. Seven incident cases progressed to AIDS and the cumulative progression to AIDS at 1, 3, and 5 years after seroconversion was 2%, 6%, and 22%, respectively. The cumulative probability of AIDS at 4 years from entering stages 1, 2, and 3 was 11%, 33%, and 58%, respectively. There were 47 deaths among prevalent cases and seven among incident cases during follow-up. The cumulative mortality 4 years after patients entered stages 1, 2, 3, and 4 was 9%, 33%, 56%, and 86%, respectively. The median survival after the onset of AIDS was 9.3 months.
Our results are important for the setting of priorities and rationalisation of treatment availability in countries with poor resources. We found that progression rates to AIDS are similar to those in developed countries for homosexual cohorts and greater than for cohorts infected by other modes of transmission. However, we have found that the rates of all-cause mortality are much higher and the progression times to death are shorter than in developed countries.
大多数感染HIV-1的人生活在非洲，但对该疾病在非洲大陆的自然史了解甚少。我们根据世界卫生组织提议的分期系统，对乌干达一个以人群为基础的农村队列中的存活时间、疾病进展和艾滋病界定疾病进行了研究。
1990年，我们在一项普通人群研究的首轮调查中，随机抽取了已感染HIV-1的人群（作为现患病例）组成一个自然史队列。1990年至1995年间血清阳转的普通人群队列中的个体（新发病例）也被邀请入组。参与者每3个月定期接受检查，病情达到Ⅲ期时也进行检查。
到1995年底，共纳入93例现患病例和86例新发病例。现患组中有4例患者在初次就诊时处于4期（艾滋病期）。在接下来的5年里，37例现患病例进展为艾滋病。7例新发病例进展为艾滋病，血清阳转后1年、3年和5年累计进展为艾滋病的比例分别为2%、6%和22%。从进入1期、2期和3期起4年时艾滋病的累计概率分别为11%、33%和58%。随访期间，现患病例中有47例死亡，新发病例中有7例死亡。患者进入1期、2期、3期和4期后4年的累计死亡率分别为9%、33%、56%和86%。艾滋病发病后的中位生存期为9.3个月。
我们的研究结果对于资源匮乏国家确定优先事项和合理安排治疗资源具有重要意义。我们发现，艾滋病的进展率与发达国家同性恋队列相似，高于其他传播方式感染的队列。然而，我们发现全因死亡率远高于发达国家，死亡进展时间也短于发达国家。
