Morgan D, Ross A, Mayanja B, Malamba S, Whitworth J
Medical Research Council Programme on AIDS, Uganda Virus Research Institute, Entebbe.
AIDS. 1998 Apr 16;12(6):591-6. doi: 10.1097/00002030-199806000-00007.
To describe the early manifestations of HIV-1 infection before the development of AIDS, in a rural Ugandan population.
Three monthly follow-up of HIV-1-infected and uninfected participants in an HIV-1 natural history cohort from the start of the cohort in 1990 to the end of 1996.
A total of 107 persons with prevalent infection and 104 persons with incident infection were enrolled. Eighty (75%) prevalent and 89 (86%) incident individuals were asymptomatic on enrollment. Of the 91 persons with incident infection seen within 2 years of their estimated date of seroconversion, 51% [95% confidence interval (CI), 40-61] were still asymptomatic 2 years after seroconversion. At 4 and 5 years after seroconversion, only 26% (95% CI, 17-36) and 11% (95% CI, 4-22), respectively, remained asymptomatic. A total of 89 participants entered World Health Organization (WHO) stage 2, and their main stage-defining conditions were weight loss <10% (and > 5%) and minor mucocutaneous manifestations. The median CD4 lymphocyte count for participants entering WHO stage 2 was 516 x 10(6) cells/l (interquartile range, 360-884 x 10(6)/l). A total of 94 participants entered WHO stage 3 and the main reasons were weight loss >10%, unexplained chronic diarrhoea, fever for more than 1 month, and severe bacterial infection. The median CD4 lymphocyte count for participants entering WHO stage 3 was 428 x 10(6) cells/l (interquartile range, 276-736 x 10(6)/l). The rates of all conditions reported under the WHO staging system were significantly more frequent in HIV-positive persons than HIV-negative controls with the exception of fever for more than 1 month and oral hairy leukoplakia (which was seen in only three individuals).
These are the first data from a non-selected African population describing the early manifestations of HIV infection. The main early manifestations were weight loss, minor mucocutaneous features, chronic diarrhoea, chronic fever and severe bacterial infections. The apparent rapid development of HIV-related signs and symptoms is probably indicative of the high background level of these conditions in our study area, as reflected by the rates of these conditions in the HIV-negative controls.
描述乌干达农村地区人群在艾滋病发展之前的HIV-1感染早期表现。
对一个HIV-1自然史队列中感染和未感染HIV-1的参与者进行为期三个月的随访，该队列从1990年开始到1996年底结束。
共纳入107名既往感染者和104名新感染者。80名（75%）既往感染者和89名（86%）新感染者在入组时无症状。在估计血清转化日期后2年内观察到的91名新感染者中，51%[95%置信区间（CI），40 - 61]在血清转化后2年仍无症状。在血清转化后4年和5年，分别仅有26%（95%CI，17 - 36）和11%（95%CI，4 - 22）仍无症状。共有89名参与者进入世界卫生组织（WHO）2期，其主要的分期界定条件为体重减轻<10%（且>5%）和轻微的皮肤黏膜表现。进入WHO 2期的参与者的CD4淋巴细胞计数中位数为516×10⁶个细胞/升（四分位间距，360 - 884×10⁶/升）。共有94名参与者进入WHO 3期，主要原因是体重减轻>10%、不明原因的慢性腹泻、发热超过1个月以及严重细菌感染。进入WHO 3期的参与者的CD4淋巴细胞计数中位数为428×10⁶个细胞/升（四分位间距，276 - 736×10⁶/升）。除发热超过1个月和口腔毛状白斑（仅在3例个体中出现）外，WHO分期系统报告的所有病症发生率在HIV阳性者中均显著高于HIV阴性对照。
这些是来自未经过选择的非洲人群描述HIV感染早期表现的首批数据。主要的早期表现为体重减轻、轻微的皮肤黏膜特征、慢性腹泻、慢性发热和严重细菌感染。HIV相关体征和症状的明显快速发展可能表明我们研究地区这些病症的背景水平较高，这在HIV阴性对照中这些病症的发生率上得到了体现。
