Nagappan Vijayalakshmi, Kazanjian Powel
Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan 48109-0378, USA.
HIV Clin Trials. 2005 Jul-Aug;6(4):213-28. doi: 10.1310/a3q4-uqqn-x9en-y4he.
The purpose of this article is to critically review articles published from the pre-HAART era to the present on bacterial infections in adult HIV-infected patients.
Literature search on bacterial infections in HIV-infected patients yields predominantly small case series from single centers, many of which are retrospectively collected.
Variations in case selection limit the utility of these articles for assessing the epidemiology and clinical features of a particular infection. Nonetheless, numerous articles indicate that certain bacterial infections occur most often when CD4 cell counts are < 200/mm3. In the pre-HAART era, others suggest that PcP prophylaxis with TMP/SMX and MAC prophylaxis with macrolides reduced rates of several bacterial infections. Since the advent of HAART, however, some articles suggest that the incidence of various infections has declined and that withdrawal of OI prophylaxis in patients who have had HAART restoration of CD4 cell counts has not led to an increase in certain bacterial infections.
This review suggests that bacterial infections may have declined in the HAART era, as multicenter cohort studies have shown to be the case with AIDS-associated OIs. Nonetheless, preventive measures such as pneumococcal vaccination and smoking cessation remain effective strategies.
本文旨在批判性地回顾从高效抗逆转录病毒治疗（HAART）时代之前到现在发表的关于成年HIV感染患者细菌感染的文章。
对HIV感染患者细菌感染的文献检索主要得到来自单一中心的小型病例系列，其中许多是回顾性收集的。
病例选择的差异限制了这些文章在评估特定感染的流行病学和临床特征方面的效用。尽管如此，大量文章表明，当CD4细胞计数<200/mm³时，某些细菌感染最常发生。在HAART时代之前，其他研究表明，使用甲氧苄啶/磺胺甲恶唑（TMP/SMX）预防肺孢子菌肺炎（PcP）和使用大环内酯类药物预防鸟分枝杆菌复合体（MAC）感染可降低几种细菌感染的发生率。然而，自HAART出现以来，一些文章表明各种感染的发生率有所下降，并且在CD4细胞计数因HAART恢复的患者中停止机会性感染（OI）预防并未导致某些细菌感染增加。
本综述表明，在HAART时代细菌感染可能有所下降，正如多中心队列研究显示的与艾滋病相关的机会性感染情况一样。尽管如此，诸如肺炎球菌疫苗接种和戒烟等预防措施仍然是有效的策略。
