Le Moing V, Rabaud C, Journot V, Duval X, Cuzin L, Cassuto J P, Al Kaied F, Dellamonica P, Chêne G, Raffi F
Infectious and Tropical Diseases Department, Hôpital Gui de Chauliac, Montpellier, France.
HIV Med. 2006 May;7(4):261-7. doi: 10.1111/j.1468-1293.2006.00370.x.
To describe the incidence and risk factors of bacterial pneumonia occurring in patients treated with antiretrovirals.
In the ongoing APROCO (Anti-proteases) cohort, 1281 patients at the initiation of a protease inhibitor (PI)-containing antiretroviral regimen were enrolled from 1997-1999. All events requiring hospitalization during follow up are recorded. Of these, bacterial pneumonia was defined as the occurrence of a new pulmonary infiltrate with fever and either evidence of a bacteriological cause (definite cases) or favourable outcome with antimicrobial therapy (presumptive cases). Risk factors of bacterial pneumonia were studied using survival analyses.
During a median follow up of 43 months, 29 patients had at least one episode of bacterial pneumonia, giving an incidence of 0.8/100 patient years. The 11 definite cases were attributable to Streptococcus pneumoniae (n=9), Legionella pneumophila (n=1) and Haemophilus influenzae (n=1). In multivariate analysis, bacterial pneumonia was significantly more frequent in older patients, injecting drug users, patients having a CD4 cell count>500 cells/microL at baseline and patients who initiated PI therapy with nonboosted saquinavir. It was significantly less frequent in nonsmokers. The occurrence of bacterial pneumonia was also associated with lower self-reported adherence to antiretroviral therapy and to higher plasma HIV-1 RNA levels during follow-up.
Bacterial pneumonia occurs rarely in patients treated with a PI-containing regimen and may be associated with virological failure.
描述接受抗逆转录病毒治疗的患者发生细菌性肺炎的发病率及危险因素。
在正在进行的APROCO（抗蛋白酶）队列研究中，1997年至1999年纳入了1281例开始含蛋白酶抑制剂（PI）的抗逆转录病毒治疗方案的患者。记录随访期间所有需要住院治疗的事件。其中，细菌性肺炎定义为出现新的肺部浸润影并伴有发热，且有细菌学病因证据（确诊病例）或抗菌治疗有效（疑似病例）。采用生存分析研究细菌性肺炎的危险因素。
在中位随访43个月期间，29例患者至少发生1次细菌性肺炎，发病率为0.8/100患者年。11例确诊病例归因于肺炎链球菌（n = 9）、嗜肺军团菌（n = 1）和流感嗜血杆菌（n = 1）。多因素分析显示，老年患者、注射吸毒者、基线CD4细胞计数>500个/微升的患者以及开始使用未增效沙奎那韦进行PI治疗的患者发生细菌性肺炎的频率显著更高。不吸烟者发生细菌性肺炎的频率显著更低。细菌性肺炎的发生还与自我报告的抗逆转录病毒治疗依从性较低以及随访期间较高的血浆HIV-1 RNA水平相关。
接受含PI方案治疗的患者很少发生细菌性肺炎，且可能与病毒学失败有关。
