Vanhems P, Lambert J, Cooper D A, Perrin L, Carr A, Hirschel B, Vizzard J, Kinloch-de Loës S, Allard R
Hôtel-Dieu de Montréal, and the Department of Social and Preventive Medicine, University of Montreal, Quebec, Canada.
Clin Infect Dis. 1998 Feb;26(2):323-9. doi: 10.1086/516289.
This study examined the relationship between the severity of acute human immunodeficiency virus type 1 (HIV-1) illness and disease progression and death. The population included 218 patients with acute HIV-1 illness and 41 asymptomatic patients who underwent HIV-1 seroconversion; the patients were followed up prospectively. We analyzed progression to Centers for Disease Control and Prevention clinical categories B and C (AIDS-defining conditions) and death according to an additive clinical score (CS) based on six predictive clinical features at the time of acute HIV-1 infection. Compared with patients with a CS of 0 (asymptomatic patients), those with a CS of 3-4 and 5-6 had faster progression to category B disease (adjusted hazard ratio [HR], 1.39; 95% confidence interval [CI], 1.01-1.92; and HR, 1.80; 95% CI, 1.34-2.40; respectively); those with a CS of 5-6 had faster progression to category C disease (HR, 1.37; 95% CI, 1.01-1.89) and death (HR, 2.05; 95% CI, 1.27-3.32). Thus, the number of symptoms and signs at the time of acute HIV-1 illness affects disease progression and survival, even in symptomatic patients who have undergone seroconversion.
本研究调查了1型人类免疫缺陷病毒（HIV-1）急性感染疾病的严重程度与疾病进展及死亡之间的关系。研究人群包括218例HIV-1急性感染患者和41例经历HIV-1血清转化的无症状患者；对这些患者进行了前瞻性随访。我们根据急性HIV-1感染时的六个预测性临床特征，分析了进展至美国疾病控制与预防中心临床分类B和C（艾滋病定义疾病）以及死亡的情况，采用的是累加临床评分（CS）。与CS为0的患者（无症状患者）相比，CS为3 - 4和5 - 6的患者进展至B类疾病的速度更快（调整后风险比[HR]分别为1.39；95%置信区间[CI]为1.01 - 1.92；以及HR为1.80；95% CI为1.34 - 2.40）；CS为5 - 6的患者进展至C类疾病的速度更快（HR为1.37；95% CI为1.01 - 1.89）且死亡风险更高（HR为2.05；95% CI为1.27 - 3.32）。因此，急性HIV-1感染疾病时症状和体征的数量会影响疾病进展和生存，即使是经历了血清转化的有症状患者也是如此。
