Beck E J, Mandalia S, Miller D L, Harris J R
Department of Epidemiology and Public Health, St Mary's Hospital and Medical School, London, UK.
Int J STD AIDS. 1998 May;9(5):280-90. doi: 10.1258/0956462981922214.
The relationship between changes in hospital service interventions at St Mary's Hospital, London, reduced case fatality for patients with their first episode of Pneumocystis carinii pneumonia (PCP) and improved survival from diagnosis of AIDS was investigated for the period 1982-1991. Multivariate logistic regression models identified factors independently associated with episode survival; for those patients who survived their first episode of PCP, survival from time of diagnosis of AIDS was analysed using multivariate Cox's proportional hazards models. The case-fatality rate after 1987 was significantly lower for the 159 subjects. Median survival from diagnosis of AIDS increased significantly from 142 days to 554 days (P=0.01). Improved survival of first episode of PCP was associated with it being the index diagnosis and having a haemoglobin at diagnosis of PCP greater than 12 g/dl. The presence of a concurrent AIDS-defining condition in patients who presented with an A-a gradient equal to or greater than 40 mmHg was associated with reduced episode survival, especially before 1987. For the 126 individuals who survived their first episode of PCP, death rates were lowest in patients treated with primary or secondary PCP prophylaxis and those who received zidovudine since their first episode of PCP. Survival in patients with HIV disease is better in patients who receive appropriate antiretroviral treatment of HIV infection and timely treatment of opportunistic illnesses. Early diagnosis of HIV-1 infection with early diagnosis and treatment of first episode of PCP was associated with improved episode survival. Subsequent medical follow up combined with PCP prophylaxis and zidovudine were significantly associated with long-term survival.
对1982年至1991年期间伦敦圣玛丽医院的医院服务干预措施变化、卡氏肺孢子虫肺炎（PCP）首发患者病死率降低以及艾滋病诊断后生存率提高之间的关系进行了调查。多变量逻辑回归模型确定了与发作期生存独立相关的因素；对于那些在PCP首发发作中存活下来的患者，使用多变量考克斯比例风险模型分析了自艾滋病诊断后的生存情况。1987年后，159名受试者的病死率显著降低。艾滋病诊断后的中位生存期从142天显著增加到554天（P = 0.01）。PCP首发发作生存率的提高与作为索引诊断以及PCP诊断时血红蛋白大于12 g/dl有关。在出现动脉血氧分压差（A-a）梯度等于或大于40 mmHg的患者中，同时存在艾滋病定义疾病与发作期生存率降低有关，尤其是在1987年之前。对于126名在PCP首发发作中存活下来的个体，接受原发性或继发性PCP预防治疗的患者以及自PCP首发发作后接受齐多夫定治疗的患者死亡率最低。接受适当的抗逆转录病毒治疗和及时治疗机会性疾病的HIV疾病患者生存率更高。HIV-1感染的早期诊断以及PCP首发发作的早期诊断和治疗与发作期生存率提高有关。随后的医学随访结合PCP预防和齐多夫定与长期生存显著相关。
