Begg M D, Lamster I B, Panageas K S, Mitchell-Lewis D, Phelan J A, Grbic J T
Center for Oral HIV Studies, School of Public Health, Columbia University, New York, NY 10032, USA.
Oral Dis. 1997 Sep;3(3):176-83. doi: 10.1111/j.1601-0825.1997.tb00032.x.
This report evaluates and compares individual oral lesions and combinations of lesions in predicting progression-free survival in a seroprevalent cohort of men and women with HIV infection.
This was a prospective study of HIV-infected patients, initially AIDS-free, followed for approximately 30 months.
Patients were volunteers examined at an academic medical center and at an inner-city hospital in New York. Participants identified themselves as homosexual men or as injection drug users (IDU).
The primary outcome being assessed is time from a baseline oral examination until the development of an AIDS-defining condition or death from any cause within 12 months of the last study visit. Correlation is measured by relative risk (RR).
While oral lesions were not predictive of progression among subjects with CD4 > or = 200, they were highly predictive of progression among those with CD4 < 200. For subjects with CD4 < 200, the only individual lesion that was significantly associated with progression-free survival was oral candidiasis (RR = 4.12, P = 0.009). Positivity for one or more lesions in a set demonstrated greater prognostic value among those with CD4 < 200, with RR's of 6.03 (P = 0.018) for the set consisting of oral candidiasis, hairy leukoplakia, and necrotizing ulcerative gingivitis (NUG), and 8.77 (P = 0.036) for the set consisting of the above lesions plus linear gingival erythema (LGE). Analysis by cohort suggested that the improvement in correlation was stronger in homosexual men than in IDU, but this question could not be resolved conclusively with these data.
Lesion sets might be better prognosticators of progression-free survival than individual lesions among HIV-infected subjects with CD4 < 200. Prognostic value of the core lesion set (oral candidiasis and hairy leukoplakia) was enhanced by the addition of other lesions (NUG and LGE) not usually included in HIV staging systems. These results suggest that staging systems for HIV might be improved by the inclusion of other, survival-related oral lesions.
本报告评估并比较了个体口腔病变及病变组合对一组感染HIV的血清阳性男女患者无进展生存期的预测作用。
这是一项对最初未患艾滋病的HIV感染患者进行的前瞻性研究，随访约30个月。
患者为在纽约一所学术医疗中心和一家市中心医院接受检查的志愿者。参与者自认为是男同性恋者或注射吸毒者（IDU）。
评估的主要指标是从基线口腔检查到出现艾滋病界定疾病或在最后一次研究访视后12个月内任何原因导致死亡的时间。相关性通过相对风险（RR）衡量。
虽然口腔病变对CD4≥200的受试者的病情进展无预测作用，但对CD4＜200的受试者的病情进展具有高度预测性。对于CD4＜200的受试者，唯一与无进展生存期显著相关的个体病变是口腔念珠菌病（RR = 4.12，P = 0.009）。一组中一个或多个病变呈阳性在CD4＜200的受试者中显示出更大的预后价值，由口腔念珠菌病、毛状白斑和坏死性溃疡性牙龈炎（NUG）组成的一组的RR为6.03（P = 0.018），由上述病变加线性牙龈红斑（LGE）组成的一组的RR为8.77（P = 0.036）。按队列分析表明，同性恋男性的相关性改善比IDU更强，但这些数据无法最终解决这个问题。
对于CD4＜200的HIV感染受试者，病变组合可能比个体病变更能预测无进展生存期。通过添加通常不包括在HIV分期系统中的其他病变（NUG和LGE），核心病变组合（口腔念珠菌病和毛状白斑）的预后价值得到增强。这些结果表明，纳入其他与生存相关的口腔病变可能会改善HIV分期系统。
