Impact of protease inhibitors and other antiretroviral treatments on acquired immunodeficiency syndrome survival in San Francisco, California, 1987-1996

The authors assessed temporal trends in acquired immunodeficiency syndrome (AIDS) survival for 15,271 persons in San Francisco, California, diagnosed between 1987 and 1996 with an opportunistic illness included in the 1987 AIDS case definition. Predictors of survival were evaluated for 5,686 persons who were diagnosed between 1993 and 1996 and met the 1993 AIDS case definition. Median survival was 19 months for persons diagnosed between 1987 and 1989, 17 months for persons diagnosed between 1990 and 1992, 15 months for persons diagnosed between 1993 and 1994, and 31 months for persons diagnosed between 1995 and 1996. Decreased mortality was associated with use of antiretroviral therapy without protease inhibitors before AIDS (relative hazard (RH) = 0.88, 95% confidence interval (CI): 0.8, 1.0) and after AIDS (RH = 0.83, 95% CI: 0.7, 0.9) and use of antiretroviral agents with protease inhibitors before AIDS (RH = 0.25, 95% CI: 0.2, 0.3) and after AIDS (RH = 0.36, 95% CI: 0.3, 0.4). Increased mortality was found for persons aged > or = 40 years (RH = 1.43, 95% CI: 1.3, 1.6), persons initially diagnosed with an opportunistic illness (RH = 1.97, 95% CI: 1.8, 2.2), and homosexual injection drug users (RH = 1.33, 95% CI: 1.2, 1.5). Survival after AIDS has increased. Treatment with antiretroviral agents, particularly protease inhibitors, strongly predicts improved survival.     

HIV感染者/AIDS患者社会规范认知、高危行为的差异及抑郁状况

目的 探讨HIV感染者/AIDS患者社会规范认知和高危行为之间的差异对其心理抑郁状况的影响。方法 通过方便抽样法,采用自行编制的调查问卷,对450例HIV感染者/AIDS患者的抑郁状况及影响因素进行调查。抑郁状况采用流行病调查中心抑郁量表（center for epidemiologic studies depression scale, CES-D）测量,CES-D量表得分>19分为抑郁。单因素分析采用χ2检验或t检验,多因素分析采用Logistic回归分析方法。结果 406位有效调查对象的平均抑郁得分为（16.1±11.5）分,36.9%（150/406）的调查对象处于抑郁状态。广州户籍（OR=2.260, 95% CI:1.177～4.340）、较低水平的社会支持（OR=0.985, 95% CI:0.974～0.996）、较低水平的心理弹性（OR=0.897, 95% CI:0.862～0.933）和较高水平的耻辱感（OR=1.089, 95% CI:1.052～1.128）是HIV感染者/AIDS患者抑郁的危险因素;AIDS患者自身使用安全套的行为比他的社会规范认知更好是HIV感染者/AIDS患者抑郁的保护因素（OR=0.290, 95% CI=0.094～0.894）。结论 广州市HIV感染者/AIDS患者社会规范认知与高危行为的差异是其抑郁的影响因素。     

Caregivers' and non-caregivers' knowledge regarding HIV/AIDS and attitude towards HIV/AIDS and orphans in Nigeria

Nigeria has an estimated 930,000 AIDS orphans, which has a marked impact on family and community. This study was performed to characterise caregivers' knowledge regarding HIV/AIDS and their attitude towards HIV/AIDS, orphans in general and AIDS orphans in particular. Caregivers and non-caregivers aged 25-70 years in Nigeria were interviewed from January and March 2003, and logistic regression analysis was used to determine associations between caregivers' knowledge regarding HIV/AIDS and attitudes towards HIV/AIDS, orphans and AIDS orphans, and demographic characteristics and background status regarding HIV/AIDS and orphans. A total of 824 interviewees participated in the survey (82.4% response rate), of whom 290 (35.2%) were current caregivers of orphans. The mean number of orphans per current caregiver was 1.8 (standard deviation 1.4). Factors related to higher knowledge level regarding HIV/AIDS were female gender [odds ratio (OR) = 3.49; 95% confidence interval (CI): 2.33, 5.22] and belief that AIDS is a common disease (OR = 3.39; 95% CI: 2.19, 5.26). Factors associated with positive attitudes towards HIV/AIDS, orphans in general and AIDS orphans in particular were age 35-44 years (OR = 1.73; 95% CI: 1.11, 2.69), Koranic schooling (OR = 8.69; 95% CI: 2.42, 31.19), polygamy (OR = 1.76; 95% CI: 1.17, 2.62), belief that there are increasing numbers of orphans in the community (OR = 2.59; 95% CI: 1.32, 5.08) and having relatives or friends with HIV/AIDS (OR = 2.88; 95% CI: 1.61, 1.58). There was a slight correlation (r = 0.17, P < 0.001) between caregivers' knowledge regarding HIV/AIDS and positive attitudes towards HIV/AIDS, orphans and AIDS orphans. Demographic characteristics and personal experience should be taken into consideration to improve attitudes and behaviour related to HIV/AIDS and caring for orphans and AIDS orphans.     

安徽省接受抗病毒治疗HIV/AIDS死亡的影响因素

  目的  了解安徽省接受抗病毒治疗HIV感染者和AIDS病人(简称HIV/AIDS)死亡的影响因素。  方法  采用1∶2匹配病例对照研究方法,回顾性收集2010―2019年安徽省接受抗病毒治疗HIV/AIDS的相关信息,采用条件logistic回归分析模型分析HIV/AIDS死亡的影响因素。  结果  共调查4 347例HIV/AIDS,其中死亡组1 449例,对照组2 898例。多因素条件logistic回归分析模型分析显示,影响抗病毒治疗HIV/AIDS死亡的危险因素中,发生耐药、最近一次病毒载量≥1 000 copies/mL且未检测耐药、最近一次病毒载量无结果且未检测耐药分别是不耐药的1.75倍(95% CI: 1.22~2.52, P=0.003)、2.26倍(95% CI: 1.69~3.03, P＜0.001)、35.27倍(95% CI: 26.54~46.87, P＜0.001);30~50岁和≥50岁分别是18~30岁的1.40倍(95% CI: 1.01~1.94, P=0.042)和4.02倍(95% CI: 2.80~5.77, P＜0.001);男性是女性的1.37倍(95% CI: 1.08~1.74, P=0.011);注射吸毒传播途径是异性传播途径的6.27倍(95% CI: 2.00~19.61, P=0.002);治疗前WHO临床分期为Ⅲ期/Ⅳ期是Ⅰ期/Ⅱ期的1.41倍(95% CI: 1.12~1.76, P=0.007);治疗前CD4+T淋巴细胞计数＜200个/μL是≥350个/μL的1.95倍(95% CI: 1.50~2.54, P＜0.001)。  结论  耐药、耐药检测、年龄、性别、传播途径、治疗前WHO临床分期、治疗前CD4+T淋巴细胞计数是安徽省接受抗病毒治疗HIV/AIDS发生死亡的影响因素。加强HIV/AIDS的耐药监测对减少艾滋病死亡具有重要意义,应对接受抗病毒治疗的HIV/AIDS及时进行病毒载量和耐药检测。     

城市一般人群艾滋病相关知识、态度及其影响因素调查

目的 了解城市一般人群对艾滋病知识的认识、态度情况。以确定城市一般人群艾滋病知识水平及其影响因素，为今后在一般人群中采取针对性的艾滋病知识宣传策略提供依据。方法 于2002年12月1日在广州市商业区采用街头随机拦截的方式，对一般人群采用匿名自填问卷的方法调查其艾滋病相关知识和态度。结果 本次调查共发放问卷200份，收回有效问卷147份。结果显示，艾滋病知识总知晓率为63．3％；传播途径知识总知晓率为59．2％；预防知识知晓率为46．9％；对艾滋病感染／患正确态度率为49．7％。多因素Logistic回归分析显示，艾滋病知识知晓率的影响因素为年龄、性别、化程度和婚姻状况。30～39岁年龄组(OR=0．101，95％CI：0．015～0．678)和40岁及以上年龄组(OR=0．060，95％CI：0．007～0．498)艾滋病知识总知晓率低于15～20岁年龄组；女性艾滋病知识知晓率(OR=0．230，95％CI：0．099～0．532)低于男性；化程度初中(OR=14．161。95％CI：2．195～91．364)、高中(OR=23．455，95％CI：4．568～120．434)、大专以上(OR=35．378,95％CI:6．001～208．571)艾滋病知识知晓率高于小学及以下组；已婚(OR=5．761，95％CI：1．589～20．893)高于未婚。结论 目前城市一般人群的艾滋病知识水平仍然很低，因此应进一步加强对一般人群的艾滋病知识的宣传，尤其是针对化程度低、未婚及女性人群开展艾滋病知识的宣传教育。     

Survival with AIDS in Massachusetts, 1979 to 1989.

OBJECTIVES. The goal of the study was to determine survival time after diagnosis of acquired immunodeficiency syndrome (AIDS) and to identify predictors of survival. METHODS. We conducted a population-based prospective survival analysis of all Massachusetts-resident adult AIDS patients diagnosed from January 1, 1979, through December 31, 1988. RESULTS. Median survival was 406 days, with a 5-year survival rate of 3%. Age older than 40 years (P = .001), a diagnosis other than Kaposi's sarcoma (P = .001), and a history of intravenous drug use (P < or = .01) were associated with shorter survival after confounding was controlled. Survival increased as year of diagnosis became more recent (P < .0001). This temporal effect was strongest for patients with Pneumocystis carinii pneumonia. Individuals with Kaposi's sarcoma, Hispanics, homosexual men who were concurrent intravenous drug users, and residents of the greater Boston standard metropolitan statistical area, excluding the city of Boston, did not experience increases in survival over time. CONCLUSIONS. With the exception of cases initially defined by Kaposi's sarcoma, recently diagnosed AIDS case subjects survive longer than those diagnosed earlier in the epidemic. Further work is needed to determine whether this effect is due to lead-time bias or better treatment after diagnosis.     

Risk Factors of Active Tuberculosis in People Living with HIV/AIDS in Southwest Ethiopia: A Case Control Study

Background

Determinants of active tuberculosis among People Living with HIV/AIDS (PLHA) are not well elucidated in countries with limited resources. The objective of this study was to assess distal and proximate determinants of active tuberculosis among people living with HIV/AIDS in southwest Ethiopia.

Methods

A case-control study was conducted from January to March, 2009 in South West Ethiopia. The study population consisted of 162 cases and 647 controls. Cases were adult people living with HIV/AIDS who developed active pulmonary tuberculosis and controls were people living with HIV/AIDS without active tuberculosis. An interviewer administered structured questionnaire was used to collect information on potential risk factors.

Results

After adjustment for potential confounders, male gender (OR=1.7; 95%CI: 1.1, 2.7), a low level of education (OR=2.8; 95% CI: 1.1, 7.1), a body mass index less than 18.5 kg/m2 (OR=4.1; 95% CI: 2.3, 7.4), hemoglobin level less than 10.0 g/dl (OR=2.8; 95%CI: 1.5, 5.2), a CD4 lymphocyte count less than 200 cells/µL (OR=9.8‘95% CI: 5.5, 17.5), a WHO clinical stage IV (OR=4.3; 95% CI: 2.6, 6.8), not taking antiretroviral treatment (OR=3.1; 95%CI: 1.9,4.9), an infection with helminthes (OR=2.2; 95% CI: 1.4, 3.4), a history of contact with a tuberculosis patient in the family (OR=2.0; 95% CI: 1.2, 3.3), and living in a house made of mud wall (OR=3.7; 95% CI: 1.5, 7.5) were independently associated with the development of active tuberculosis in people living with HIV/AIDS.

Conclusion

All people living with HIV/AIDS should be screened for tuberculosis but in the presence of the risk factors mentioned above, intensified screening is recommended.     

The nutritional status of 1081 elderly people residing in publicly funded shelter homes in Peninsular Malaysia

OBJECTIVES: The aim of this study was to determine the: (1) prevalence of undernutrition as determined by the 'DETERMINE Your Nutritional Health Checklist' (NHC) and (2) factors independently associated with undernutrition among the older residents of these publicly funded shelter homes in Peninsular Malaysia. DESIGN: A total of 1081 elderly people (59%M) over the age of 60 y were surveyed using questionnaires determining baseline demographics, nutritional and cognitive status, physical function and psychological well-being. SETTING: Shelter homes, Peninsular Malaysia. RESULTS: In all, 41.4% (n = 447) were nourished (score <3), 32.1% (n = 347) at moderate risk (score between 3 and 5) and 26.6% (n = 287) were at high risk of undernutrition (score>5) according to the NHC. A large proportion of subjects were underweight with 14.3% of subjects recording a low body mass index (BMI) <18.5 kg/m2 and a further 18.2% recording a BMI between 18.5 and 20 kg/m2. The residential geriatric depression score (GDS-12R) (relative risk (RR) = 1.03 (95% confidence interval (CI) 1.01-1.05); P = 0.002) and the number of illnesses (RR = 1.14 (95% CI 1.07-1.21); P < 0.001) were found to be independently associated with nutritional risk (NHC score > or = 3). Using a BMI < 18.5 kg/m2 as an objective marker for nutritional risk, the NHC was shown to have a sensitivity of 66.4% (95% CI 58.0-74.2%), specificity of 42.7% (95% CI 39.3-46.1%), positive predictive value of 16.2% (95% CI 13.3-19.5%) and a negative predictive value of 88.4% (95% CI 84.9-91.4%). CONCLUSIONS: Many elderly people residing in publicly funded shelter homes in Malaysia may be at-risk of undernutrition, and were underweight. The NHC is better used as an awareness tool rather than as a screening tool.     

辽宁省2003-2015年7255例艾滋病抗病毒治疗患者的生存分析

目的 探讨艾滋病（acquired immunodeficiency syndrome,AIDS）患者高效抗逆转录病毒治疗（highly active antiretroviral therapy,HAART）后的生存率及其影响因素。方法 采用回顾性队列研究方法,收集辽宁省2003-2015年7 255例接受HAART的人类免疫缺陷病毒（human immunodeficiency virus,HIV）感染者和AIDS患者的相关信息,用寿命表法分析其生存率,用Cox回归模型分析生存时间的影响因素。结果 共收集7 255例HIV/AIDS为研究对象,HAART后1、3、5年的累积生存率分别为97%、95%、93%,6～12年的累积生存率均为92%;其中HAART后艾滋病相关死亡269例,总病死率为1.99/100人年;Cox回归模型多因素分析显示,年龄30～59岁（HR=0.330,95%CI:0.203～0.538）、>59岁组（HR=0.569,95%CI:0.395～0.820）与<30岁组相比死亡风险低;文化程度初中（HR=0.503,95%CI:0.324～0.780）、高中及中专（HR=0.284,95%CI:0.200～0.405）、大专及以上组（HR=0.254,95%CI:0.169～0.381）与小学及以下组相比死亡风险低,感染途径为异性传播组与同性传播组相比死亡风险低（HR=0.540,95%CI:0.383～0.763）;基线CD4+T淋巴细胞计数≥200个/μl组与<50个/μl组相比死亡风险低（HR=0.316,95%CI:0.201～0.499）;BMI≥24.0 kg/m2组与<18.5 kg/m2组相比死亡风险低（HR=0.459,95%CI:0.344～0.611）。结论 辽宁省艾滋病抗病毒治疗效果稳定,5年生存率水平较高。疾病早期进行规范治疗是降低患者死亡风险、提高生存率的有效措施。     

The association between primary source of ambulatory care and access to and outcomes of treatment among AIDS patients.

OBJECTIVES: To examine the relationship between having a primary source of ambulatory care (PSAC), access to AIDS treatment and prophylaxis for opportunistic infection, and hospital and mortality outcomes among heterosexual men and women with AIDS. METHODS: Using a linked AIDS Registry-Medicaid database, 366 adults were identified (1989-1991) with at least 1 year of continuous Medicaid enrollment before AIDS diagnosis, who survived 2 weeks after diagnosis, and with no antiretroviral use or Pneumocystis carinii pneumonia (PCP) prophylaxis during the pre-diagnosis year. Outcomes included times to zidovudine treatment, PCP prophylaxis, hospitalization and death following diagnosis. Multivariate proportional hazards models were used to estimate the effects of patients' PSAC status in the 12-month post-diagnosis period on outcomes, controlling for demographic and case-mix variables. RESULTS: Study criteria preferentially included females, non-whites and enrollees eligible on the basis of aid to families with dependent children. A total of 49% of the patients had no PSAC. Patients with a PSAC were more likely to have received zidovudine [relative risk (RR) = 1.75, 95% confidence interval (CI) = 1.2, 2.2] or PCP prophylaxis (RR = 2.22, 95% CI = 1.5, 3.3). Regression models simultaneously examining association of the propensity to use zidovudine and PCP prophylaxis agents with death indicated that zidovudine-treated and PCP-prophylaxed patients were 64% and 51% less likely to die, respectively (RRdeath,zidovudine = (.36, 95% CI = 0.2, 0.4; RRdeath, PCP prophylaxis = 0.49, 95% CI = 0.3, 0.8). CONCLUSIONS: Patients' underuse of zidovudine and PCP prophylaxis was systematically associated with not having a PSAC. Lack of PSAC, in turn, predicted shorter survival but not increased hospitalization. Female gender, injecting drug use, non-white race and earlier diagnosis year also predicted poorer outcomes.     

360例门诊HIV/AIDS患者焦虑症现患率的研究

目的 了解目前人类免疫缺陷病毒（human immunodeficiency virus,HIV）/获得性免疫缺陷综合征（acquired immune deficiency syndrome,AIDS）患者中焦虑症的患病率,初步探索影响焦虑症产生的因素。方法 抽取2015年6~12月在长沙市传染病医院艾滋病门诊就诊的360例HIV/AIDS患者并对其开展横断面研究,采用量表结合诊断软件的双重筛查方法评估患者合并焦虑症的情况,对于宗氏焦虑自评量表（self-rating anxiety scale,SAS）筛查调查对象有焦虑症状者（SAS最后得分 ≥ 50分）,应用心理疾病专家诊断系统（心理CT）确诊是否患焦虑症,并用多因素Logistic回归分析影响焦虑症产生的因素。结果 初筛检出焦虑症状72例（占20.0%）,确诊焦虑症34例（占9.4%）。多因素分析结果显示,1年 ≤ 确诊时间<3年（OR=3.388,95%CI:1.335~8.599）、近三个月有艾滋病相关疾病（OR=3.623,95%CI:1.561~8.409）、HIV/AIDS相关羞辱和歧视状况量表得分高（40分 ≤ 得分<60分,OR=4.595,95%CI:1.666~12.674;得分 ≥ 60分,OR=12.278,95%CI:3.376~44.656）是HIV/AIDS患者焦虑症形成的危险因素。结论 接受抗病毒治疗HIV/AIDS患者焦虑症患病情况应该引起关注,临床应加大对HIV/AIDS患者的心理关怀力度。     

Adherence to the Mediterranean food pattern predicts the prevalence of hypertension, hypercholesterolemia, diabetes and obesity, among healthy adults; the accuracy of the MedDietScore

OBJECTIVE: We sought to evaluate the accuracy of a diet score in relation to hypertension, hypercholesterolemia, diabetes and obesity. METHODS: A diet score (range 0-55) has been developed that assesses adherence to the Mediterranean diet. For the consumption of items presumed to be close to Mediterranean dietary pattern (non-refined cereals, fruits, vegetables, legumes, olive oil, fish and potatoes) scores 0 to 5 for never, rare, frequent, very frequent, weekly and daily consumption were assigned, while for the consumption of foods presumed to be away from this pattern (red meat and products, poultry and full fat dairy products) scores on a reverse scale were assigned. Positive and negative predictive values, in relation to hypertension, hypercholesterolemia, diabetes and obesity status of the ATTICA study participants (n=3042, enrolment 2001-02 in Athens metropolitan area, aged 18-89 years) were calculated and the 10-year CHD risk based on Framingham equations was estimated, too. RESULTS: The positive predictive values of the score regarding hypertension, hypercholesterolemia, diabetes and obesity are: 45% (95% CI 43%-48%), 46% (95% CI 44%-49%), 12% (95% CI 11%-14%) and 33% (95% CI 30%-35%), while the negative predictive values are 86% (95% CI 85%-88%), 71% (95% CI 69%-74%), 98% (95% CI 97%-99%) and 97% (95% CI 96%-98%), respectively. Moreover, a 10-unit increase in the diet score is associated with 4% lower 10-year CHD risk (+/-0.1%, p<0.001). CONCLUSION: The proposed Mediterranean Diet Score may be useful in detecting individuals prone to the development of nutrition-related health conditions and cardiovascular disease.     

Anthropometric indices as predictors of survival in AIDS adults. Aquitaine Cohort,France, 1985–1997

The aim of the study was to assess the performance of weight related nutritional markers [reported involuntary weight loss (WL) greater than 10%, measured WL and body mass index (BMI)] in predicting survival at AIDS stage. The three anthropometric indices were used as time dependant variables in Cox models to predict survival at AIDS stage. The studied sample included 630 HIV1-infected individuals of a prospective cohort of those 421 died (median survival at AIDS stage: 19.9 months). After adjustment for usual prognostic factors of survival, the reported WL greater than 10% was a pejorative predictor of survival (hazard ratio (HR) 2.4; 95% confidence interval (CI): 1.9–3.0). For measured WL <5%, between 5 and 10% and 10% of baseline weight compared with no WL, HR were respectively, 1.9 (CI: 1.4–2.6), 3.3 (CI: 2.4–4.4) and 6.7 (CI: 5.2–8.6). The HR of death were 2.2 (CI: 1.6–3.0) for BMI between 16 and 18.4 kg/m²and 4.4 (CI: 3.1–6.3) for BMI <16 compared to normal BMI (18.5). Even a limited WL measured at a given point in time during follow up increases the risk of death at the AIDS stage. Simple cross-sectional measures of BMI have a good predictive value of survival.     

成都市2010—2019年新报告HIV/AIDS病例晚发现的影响因素及晚发现病例的生存情况分析

目的 了解成都市艾滋病病毒感染者和艾滋病病人（简称HIV/AIDS）的晚发现情况及主要影响因素,为当地艾滋病防控工作提供建议。方法 收集成都市2010—2019年10年间新报告的HIV/AIDS的数据,采用χ2检验和多因素logistic回归分析,计算比值比,95%可信区间值。分析不同病例生存情况并绘制生存曲线。结果 共纳入39 230例研究对象,总晚发现率为34.4%,多因素logistic回归分析显示,女性出现晚发现的可能性更低（OR = 0.77,95%CI:0.73～0.82）,随年龄增加出现晚发现的可能性逐渐增高,家务、家政及待业较农民更易出现晚发现（OR = 1.12,95%CI:1.05～1.19）,外地户籍较本地户籍出现晚发现可能性更低（OR = 0.83,95%CI:0.79～0.88）,以医院就诊人群为参考,样本来源为重点人群（OR = 0.65,95%CI:0.61～0.68）、羁押人群（OR = 0.25,95%CI:0.20～0.31）、献血人群（OR = 0.31,95%CI:0.25～0.39）和其他（OR = 0.50,95%CI:0.42～0.59）出现晚发现的可能性更低。晚发现病例生存时间为（32.3±30.8）月,非晚发现病例为（42.1±31.6）月。结论 成都市近几年发现的HIV/AIDS晚发率呈下降趋势。性别、年龄、样本来源是晚发现的影响因素,非晚发现病例的平均生存时间远高于晚发现病例的平均生存时间。     

基于随机森林算法的农村中老年男性艾滋病歧视现状及其影响因素分析

目的 利用随机森林算法对农村地区≥50岁男性的艾滋病歧视现状及其影响因素进行分析,提出针对性反歧视干预措施。方法 2021年8—12月,采用艾滋病知识问卷、中文版Zelaya艾滋病歧视量表对彭州市3个乡镇240名听说过艾滋病的中老年男性进行面对面访谈式问卷调查。使用随机森林算法对变量进行重要性排序并降维,将筛选后的变量纳入有序logistic回归。结果 在240名农村中老年男性中,平均年龄（66.01±8.42）岁,艾滋病知识知晓率为29.6%,艾滋病歧视总得分均值为（3.00±0.68）分,在歧视各维度中,耻辱偏见得分最高。艾滋病知识知晓率与艾滋病歧视总得分呈负相关（r=-0.203,P=0.002）。随机森林算法显示,变量数为5时袋外估算误差率最低,依次为艾滋病知识得分、个人月收入、年龄、居住情况、文化程度。有序logistic回归分析显示,艾滋病知识得分低（OR=0.762,95%CI:0.672～0.863）、60岁及以上年龄组（OR=1.927,95%CI:1.029～3.534）、独居（OR=2.902,95%CI:1.089～7.736）、小学及以下者（OR=2.036,...     

Self-rated health compared with objectively measured health status as a tool for mortality risk screening in older adults: 10-year follow-up of the Bambuí Cohort Study of Aging

Interest in self-rated health (SRH) as a tool for use in disease and mortality risk screening is increasing. The authors assessed the discriminatory ability of baseline SRH to predict 10-year mortality rates compared with objectively measured health status. Principal component analysis was used to create a health score that included systolic blood pressure, presence of diabetes mellitus, body mass index, electrocardiographic parameters, B-type natriuretic peptide, and other biochemical and hematologic measures. From 1997 to 2007, a total of 474 of the 1,388 baseline participants died and 81 were lost to follow-up, yielding 11,833 person-years of observation. The adjusted hazard ratio for death was 1.74 (95% confidence interval (CI): 1.32, 2.29) for persons reporting poor health versus those reporting good health. When combined with age and sex, SRH had a C statistic to predict death equal to 0.69 (95% CI: 0.67, 0.71), which was comparable to that of the inclusive health score (C = 0.69, 95% CI: 0.67, 0.72). The addition of other parameters, such as lifestyle, physical functioning, mental symptoms, and physical symptoms, had little effect on these 2 predictive models (C = 0.71 (95% CI: 0.69, 0.73) and C = 0.71 (95% CI: 0.69, 0.74), respectively). The abilities of the SRH and the health score models to predict death decreased in parallel fashion over time. These results suggest that older adults who report poor health warrant particular attention as persons who have accumulated biologic markers of disease.     

The interruption of outpatient clinical care of HIV-infected patients

OBJECTIVE: To determine factors associated with the interruption of outpatient care of HIV-positive patients. METHODS: Non-concurrent prospective study carried out in a public AIDS referral center in Belo Horizonte, Brazil. Medical records were reviewed in order to assess factors associated with the interruption of clinical care of HIV patients admitted between 1993 and 1995. Patients should have attended at least one follow-up visit within a period of 7 months. Statistical analysis was carried out using Chi-square and relative hazard (RH) with 95% confidence interval (CI) estimated by Cox Regression Model. RESULTS: Cumulative incidence of interruption was 54% among 517 patients included in the study (mean follow-up=24.6 months; 26.5/100 person-years). Multivariate analysis indicated that those individuals who had fewer (<2) CD4+ T lymphocyte cell counts (RH=1.94; 95% CI=1.32-2.84) did not have viral load measured (RH=14.94; IC 95%=5.44-41.04), attended <7 medical follow-up visits (RH =2.80; IC 95%=1.89-4.14), did not change clinical category (RH =1.40; IC 95% =1.00-1.93) and did not undergo any anti-retroviral therapy (RH =1.43; IC 95% =1.06-1.93) had independently an increased risk of interrupting clinical care. CONCLUSIONS: The rate of clinical interruption in this center is high. The results suggest that interruption may be a function of better clinical outcome, i.e. the service may give priority to those patients with more severe clinical condition, and interruption of clinical care may be a marker for future antiretroviral compliance.     

Geographical variation in disease progression in HIV-1 seroconverted injecting drug users in Europe?

BACKGROUND: Human immunodeficiency virus (HIV) disease progression might vary by geographical region due to differences in the spectrum of HIV-related illnesses and (access to) health care. Therefore, the effect of geographical region, next to the effect of other potential cofactors, on disease progression in 664 injecting drug users (IDU) with documented HIV seroconversion from eight cohorts in Europe was studied. METHODS: Kaplan-Meier methods and Cox proportional hazards analysis were performed to assess the effect of geographical region, other sociodemographics, drug use and repeated HIV exposure on progression from HIV seroconversion to immunosuppression, AIDS and death with AIDS. We considered the confounding effect of study-design related factors (e.g. setting of follow-up), and accounted for pre-AIDS death from natural causes by imputing when each endpoint would have occurred, had they not died without AIDS. RESULTS: Estimates of progression to AIDS and death with AIDS were substantially faster after taking pre-AIDS mortality into account. Median incubation time from seroconversion to the first CD4 count < 200 cells/microliter was 7.7 years (95% CI: 7.1-8.3) and to AIDS 10.4 years (95% CI: 9.8-infinity). The 10-year survival was 70.3% (95% CI: 62.8-76.6). The relative hazards (RH) of AIDS for IDU from central and southern Europe compared with IDU from northern Europe was 1.9 (95% CI: 1.2-3.0) and 1.2 (95% CI: 0.6-2.3), respectively, before, and 1.5 (95% CI: 0.7-3.2) and 1.1 (95% CI: 0.6-2.3) after taking differences in study-design related factors into account. Accounting for these factors, the RH of death with AIDS was 0.9 (95% CI: 0.3-2.5) for central and 1.2 (95% CI: 0.4-3.4) for southern Europe compared with northern Europe. For the first CD4 count < 200 cells/microliter these figures were 0.8 (95% CI: 0.5-1.4) and 0.8 (95% CI: 0.5-1.4). Age at seroconversion was the strongest predictor of disease progression. No statistically significant differences in disease progression were found by gender, foreign nationality, drug use and potential repeated HIV exposure. CONCLUSIONS: We found no evidence for regional variability in HIV disease progression among European IDU. Future studies evaluating geographical differences should consider the confounding effect of study-design related factors and differential non-AIDS mortality. As age is an important determinant of disease progression, it should be considered in recommending treatment.     

云南省德宏州3103例艾滋病患者抗病毒治疗后生存分析

目的 了解云南省德宏州艾滋病患者接受国家免费抗病毒治疗后的生存情况.方法 采用回顾性研究,对德宏州2004年7月1日至2009年12月31日接受国家免费抗病毒治疗、入组抗病毒治疗时CD4+T淋巴细胞计数＜350个/μl、且年满16周岁的所有艾滋病患者进行分析.结果 共计3103例艾滋病患者开展了抗病毒治疗,平均年龄(36.0±9.9)岁,62.4%是男性,感染途径以经异性性传播为主(66.2%).病例平均随访治疗时间为21.7个月,绝大部分病例依从性＞90%,即平均每月漏服次数不足1～5次.抗病毒治疗后,第1、2、3、4、5年的累计生存率分别为0.95、0.94、0.93、0.92和0.92.Cox比例风险回归模型分析发现:在控制了年龄、性别、婚姻状况等因素的潜在混杂作用影响后,基线CD4+T淋巴细胞计数水平以及传播途径与其生存时间之间存在统计学关联.基线CD4+T淋巴细胞计数在200～350个/mm3之间死于艾滋病相关疾病的风险较基线CD4+T淋巴细胞计数＜200个/mm3的艾滋病患者低(HR=0.16,95%Cl:0.09～0.28)、经母婴传播等途径(不包括经异性性传播途径)感染HIV的患者死于艾滋病相关疾病的风险较经静脉注射毒品途径感染HIV者低(HR=0.35,95%Cl:0.13～1.00).结论 免费抗病毒治疗显著提高了艾滋病患者的生存率,较早启动抗病毒治疗有望取得更好的生存效果.     

某校大学生艾滋病知识调查及影响因素分析

目的：了解某校大学生的艾滋病防治知识现状,分析其可能影响因素,为艾滋病防治工作提供科学依据。方法：通过先分层后整群的抽样方法抽取某校2 500名大学生作为调查对象,自拟艾滋病防治知识问卷进行调查。结果：艾滋病防治知识的平均得分为74.19±14.88,男生高于女生（χ2=16.516,P=0.000）,高年级者高于低年级者（Z=7.765,P=0.000）,独生子女高于非独生子女（χ2=7.639,P=0.006）,不同专业得分不同（χ2=17.718,P=0.013）。非条件Logistic回归分析显示：女生得分低于男生（OR=0.686,95%CI：0.548～0.860）,二年级（OR=1.865,95%CI：1.455～2.390）、三年级（OR=2.671,95%CI：2.033～3.509）、四年级（OR=2.618,95%CI：1.918～3.573）得分均高于一年级。结论：高校应将女性大学生、低年级学生和非独生子学生作为重点教育人群,继续大力开展艾滋病防治宣传教育工作,不断提高大学生艾滋病防治知识和自我保健意识。