Guiguet M, Furco A, Tattevin P, Costagliola D, Molina J-M
INSERM U720, Paris, France.
HIV Med. 2007 Mar;8(2):124-30. doi: 10.1111/j.1468-1293.2007.00441.x.
To determine the incidence of Isospora belli infection in HIV-infected patients in France, and to study risk factors.
The French Hospital Database on HIV (FHDH) is a prospective cohort study that collects demographic, clinical and therapeutic data on patients managed in 62 hospitals. We reviewed all cases of I. belli infection recorded between 1992 and 2003. We compared the incidence in 1992-1994 [before the use of dual therapy and combination antiretroviral therapy (cART)] and in 1997-2003 (when use of cART was widespread), after stratification for CD4 cell count (< 50, 50-99, 100-199 and > 200 cells/microL).
A total of 164 patients had I. belli infection either at enrollment (n=71) or during follow up (n=93). During the study period, I. belli infection tended to occur less frequently during follow up, and to be diagnosed mainly at database enrollment. The incidence of I. belli infection during follow up fell by 79% [relative hazard (RH) 0.21; 95% confidence interval (CI) 0.13-0.33] in the cART period compared with the pre-cART period; no such change was noted among patients with CD4 cell counts below 50 cells/microL. In multivariable analysis, the risk of I. belli infection was significantly higher among patients from sub-Saharan Africa (RH 4.3; 95% CI 2.6-7.3). After adjustment for CD4 cell count, patients receiving cotrimoxazole prophylaxis were found to be at a lower risk of I. belli infection (RH 0.3; 95% CI 0.2-0.6).
In France, I. belli infection among HIV-infected patients is now mainly seen in patients from sub-Saharan Africa, who present at an advanced stage.
确定法国艾滋病毒感染患者中贝氏等孢球虫感染的发生率，并研究危险因素。
法国医院艾滋病毒数据库（FHDH）是一项前瞻性队列研究，收集了62家医院中患者的人口统计学、临床和治疗数据。我们回顾了1992年至2003年间记录的所有贝氏等孢球虫感染病例。在根据CD4细胞计数（<50、50 - 99、100 - 199和>200个细胞/微升）分层后，我们比较了1992 - 1994年[在使用双重疗法和联合抗逆转录病毒疗法（cART）之前]和1997 - 2003年（cART广泛使用时）的发病率。
共有164例患者在入组时（n = 71）或随访期间（n = 93）发生贝氏等孢球虫感染。在研究期间，贝氏等孢球虫感染在随访期间的发生频率趋于降低，且主要在数据库入组时被诊断出来。与cART前时期相比，cART时期随访期间贝氏等孢球虫感染的发病率下降了79%[相对风险（RH）0.21；95%置信区间（CI）0.13 - 0.33]；CD4细胞计数低于50个细胞/微升的患者中未观察到此类变化。在多变量分析中，撒哈拉以南非洲患者中贝氏等孢球虫感染的风险显著更高（RH 4.3；95% CI 2.6 - 7.3）。在对CD4细胞计数进行调整后，发现接受复方新诺明预防的患者贝氏等孢球虫感染风险较低（RH 0.3；95% CI 0.2 - 0.6）。
在法国，艾滋病毒感染患者中的贝氏等孢球虫感染目前主要见于撒哈拉以南非洲的患者，这些患者就诊时处于疾病晚期。
