Jongwutiwes Ubonvan, Kiertiburanakul Sasisopin, Sungkanuparph Somnuek
Division of Infectious Diseases, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Curr HIV Res. 2007 May;5(3):355-60. doi: 10.2174/157016207780636551.
Cryptococcosis is an opportunistic infection with morbidity and mortality in HIV-infected patients. Impact of antiretroviral therapy (ART) on the relapse of cryptococcosis and survival of HIV-infected patients with cryptococcosis has not been well established.
A retrospective cohort study of HIV-infected patients with cryptococcosis during 1997-2005 was conducted. Relapse and survival rates with corresponding risk factors were determined.
There were 149 patients with a mean age of 33.5+/-7.4 years and 57% were male. Median CD4 cell count was 22 cells/mm(3). After exclusion of patients who died or were lost to follow-up during the first two weeks, 127 patients were eligible for the analysis of the effect of ART on relapse and survival rates. Of 127 patients, 52 received ART. The demographic data between the two groups were similar. Median time of ART initiation after cryptococcal diagnosis was 2.6 months. The most frequent ART used was NNRTI-based regimen (88.4%). Median CD4 change at six months of ART was 97 cells/mm(3) and 87.9% achieved undetectable HIV-RNA. The cumulative 75% survival (free) from relapse duration was 10.4 months in no-ART group and 41.9 months in ART group (P<0.01). The 75% survival from cryptococcal-related mortality in no-ART group was 6.4 months whereas >54 months for ART group (P<0.01). In Cox proportional hazards model, ART was the only factor that associated with lower relapse and mortality rate (P<0.01).
ART significantly reduced relapse and mortality rate from cryptococcosis in HIV-infected patients. ART is strongly recommended in this population and should not be delayed.
隐球菌病是一种机会性感染，在HIV感染患者中具有发病率和死亡率。抗逆转录病毒疗法（ART）对隐球菌病复发及HIV感染的隐球菌病患者生存的影响尚未完全明确。
对1997年至2005年期间HIV感染的隐球菌病患者进行回顾性队列研究。确定复发率、生存率及相应的危险因素。
共有149例患者，平均年龄33.5±7.4岁，57%为男性。CD4细胞计数中位数为22个/立方毫米。排除在最初两周内死亡或失访的患者后，127例患者符合ART对复发率和生存率影响分析的条件。127例患者中，52例接受了ART。两组间人口统计学数据相似。隐球菌诊断后开始ART的中位时间为2.6个月。最常用的ART方案是以非核苷类逆转录酶抑制剂（NNRTI）为基础的方案（88.4%）。ART治疗6个月时CD4细胞计数的中位数变化为97个/立方毫米，87.9%的患者HIV-RNA检测不到。未接受ART组从复发持续时间计算的累积75%生存（无复发）时间为10.4个月，ART组为41.9个月（P<0.01）。未接受ART组从隐球菌相关死亡率计算的75%生存时间为6.4个月，而ART组>54个月（P<0.01）。在Cox比例风险模型中，ART是与较低复发率和死亡率相关的唯一因素（P<0.01）。
ART显著降低了HIV感染患者隐球菌病的复发率和死亡率。强烈建议在该人群中使用ART，且不应延迟。
