Feikin Daniel R, Feldman Charles, Schuchat Anne, Janoff Edward N
Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Lancet Infect Dis. 2004 Jul;4(7):445-55. doi: 10.1016/S1473-3099(04)01060-6.
We examined the peer-reviewed literature on the burden of bacterial pneumonia and the effectiveness of interventions for its prevention among HIV-infected adults in developed and developing countries. Bacterial pneumonia rates were up to 25-fold higher among HIV-infected adults than in the general community, with rates increasing as CD4+ T-cell count decreases. In developed countries, cohort studies showed that highly active antiretroviral therapy (HAART) had the most consistent effect on reducing pneumonia. In a prospective cohort and case-control studies from these regions, pneumococcal polysaccharide vaccine reduced pneumococcal disease in certain subgroups, particularly those with higher CD4+ T cells/microL. In patients with fewer than 200 CD4+ T cells/microL, antimicrobial prophylaxis was usually effective in reducing pneumonia. In sub-Saharan Africa, randomised controlled trials concluded that co-trimoxazole prophylaxis decreased rates of bacterial pneumonia, but pneumococcal polysaccharide vaccine prevented neither pneumonia nor invasive pneumococcal disease. Although not yet fully evaluated in Africa, based on experience in industrialised nations, use of HAART in Africa may have substantial potential to prevent bacterial pneumonia.
我们查阅了关于细菌性肺炎负担以及发达国家和发展中国家艾滋病毒感染成人预防干预措施有效性的同行评审文献。艾滋病毒感染成人的细菌性肺炎发病率比普通人群高25倍，且随着CD4+T细胞计数的降低而上升。在发达国家，队列研究表明，高效抗逆转录病毒疗法（HAART）在降低肺炎发病率方面效果最为一致。在这些地区的前瞻性队列研究和病例对照研究中，肺炎球菌多糖疫苗在某些亚组中可降低肺炎球菌疾病，特别是CD4+T细胞/微升较高的亚组。对于CD4+T细胞/微升少于200的患者，抗菌预防通常可有效降低肺炎发病率。在撒哈拉以南非洲，随机对照试验得出结论，复方新诺明预防可降低细菌性肺炎发病率，但肺炎球菌多糖疫苗既不能预防肺炎，也不能预防侵袭性肺炎球菌疾病。尽管在非洲尚未得到充分评估，但根据工业化国家的经验，在非洲使用HAART可能具有预防细菌性肺炎的巨大潜力。
