Bahamondes M Laura, Villar Z M José, Orellana C Carolina, González R Jimena, Montenegro U Cristian
Hospital de Enfermedades Infecciosas Dr. Lucio Córdova, Santiago, Chile.
Rev Chilena Infectol. 2006 Sep;23(3):215-9. doi: 10.4067/s0716-10182006000300003. Epub 2006 Aug 4.
Highly active antiretroviral therapy (HAART) has changed the epidemiology of Pneumocystis jiroveci pneumonia (PCP) in AIDS patients. Global incidence of PCP has decreased and now it is prevalent in AIDS patients who do not receive HAART or are unsuccessfully treated with persistent immune depression. Moreover, the immunologic response to HAART has caused a PCP form which is included in the immune restoration inflammatory syndrome (IRIS). As of late 2004, 75.5% of patients cared for at Dr. Lucio Córdova Infectious Diseases Hospital were receiving HAART. This study compares PCP clinical characteristics in patients under the effect of HAART (n: 6) with those without antiretroviral therapy (n: 12). Among those with HAART, 83.3% (5/6) were without immunologic responses and 16.7% with virologic response. The median CD4 counts were low in both groups: 20 cells/mm(3) without HAART and 51 cells/mm(3) with HAART. There were no differences in most of PCP characteristics, and no IRIS cases were observed. HAART-receiving group had less severe disease and lower frequency of both, complications and steroidal therapy prescription (P 0.023).
高效抗逆转录病毒疗法(HAART)改变了艾滋病患者中耶氏肺孢子菌肺炎(PCP)的流行病学情况。全球PCP发病率有所下降,目前它在未接受HAART治疗或因持续性免疫抑制而治疗失败的艾滋病患者中较为普遍。此外,对HAART的免疫反应引发了一种PCP形式,其被纳入免疫重建炎症综合征(IRIS)。截至2004年底,在卢西奥·科尔多瓦医生传染病医院接受治疗的患者中,75.5%正在接受HAART治疗。本研究比较了接受HAART治疗的患者(n = 6)和未接受抗逆转录病毒治疗的患者(n = 12)的PCP临床特征。在接受HAART治疗的患者中,83.3%(5/6)没有免疫反应,16.7%有病毒学反应。两组的CD4细胞计数中位数都很低:未接受HAART治疗的为20个细胞/mm³,接受HAART治疗的为51个细胞/mm³。大多数PCP特征没有差异,也未观察到IRIS病例。接受HAART治疗的组疾病较轻,并发症和甾体类药物治疗处方的频率较低(P < 0.023)。