高效抗逆转录病毒治疗时代HIV感染住院患者的社区获得性细菌性肺炎

Bacterial community acquired pneumonia in HIV-infected inpatients in the highly active antiretroviral therapy era.

作者信息

Madeddu G, Porqueddu E M, Cambosu F, Saba F, Fois A G, Pirina P, Mura M S

机构信息

Dept. of Infectious Diseases, University of Sassari, Sassari, Italy.

出版信息

Infection. 2008 Jun;36(3):231-6. doi: 10.1007/s15010-007-7162-0. Epub 2008 May 10.

DOI:10.1007/s15010-007-7162-0

PMID:18463787

Abstract

INTRODUCTION

Highly active antiretroviral therapy (HAART) has deeply modified HIV/AIDS related morbidity and mortality. However, bacterial community acquired pneumonia (BCAP) still represents one of the most frequent causes of morbidity in HIV-infected patients with an inpatient 10% mortality rate.

OBJECTIVES

We retrospectively studied the characteristics of BCAP in consecutive HIV-infected inpatients hospitalized from 1999 to 2004 and evaluated the presence of risk factors and the influence of combination antiretroviral therapy receipt on BCAP outcomes.

RESULTS

We studied 84 BCAP episodes in 76 HIV-infected inpatients (63 males and 13 females) aged 27-80 years. Thirty-two (42.1%) patients were receiving combination antiretroviral treatment (CART) while 44 (57.9%) were not treated (NART). BCAP incidence progressively increased from 1999 to 2004. The overall percentage of injection drug users was >84%, of smokers >88% and alcohol abusers >32% with no statistical difference between CART and NART. Streptococcus pneumoniae was the most frequently identified pathogen (60%). Time to clinical stability was significantly longer in NART in respect of CART (p=0.011). In multivariate analysis, CDC stage C, CD4 cell count <100 x 10(6) cells/l, and S. pneumoniae etiology were predictors for time to clinical stability >7 days, while receipt of antiretroviral therapy was protective. The percentage of deaths did not differ between CART and NART; most patients had a CD4 count <200 x 10(6) cells/l or severe concomitant diseases.

CONCLUSIONS

The incidence of BCAP was high in HIV-infected inpatients observed in the present study mainly due to HIV infection itself, IVDU, alcohol abuse and smoking habit. A longer time to clinical stability was associated with advanced HIV infection and with S. pneumoniae etiology, while receipt of antiretroviral therapy was protective. Injection drug abuse treatment, alcohol abuse and smoking cessation programs, antiretroviral treatment adherence support and pneumococcal vaccination should be implemented to reduce the incidence and to improve the outcomes of BCAP in HIV-infected patients.

摘要

引言

高效抗逆转录病毒疗法（HAART）已深刻改变了与HIV/AIDS相关的发病率和死亡率。然而，社区获得性细菌性肺炎（BCAP）仍是HIV感染患者最常见的发病原因之一，住院患者死亡率达10%。

目的

我们回顾性研究了1999年至2004年期间连续住院的HIV感染患者中BCAP的特征，评估了危险因素的存在情况以及联合抗逆转录病毒治疗对BCAP预后的影响。

结果

我们研究了76例年龄在27至80岁之间的HIV感染住院患者中的84次BCAP发作。32例（42.1%）患者正在接受联合抗逆转录病毒治疗（CART），而44例（57.9%）未接受治疗（NART）。BCAP发病率从1999年至2004年逐渐上升。注射吸毒者总体比例>84%，吸烟者>88%，酗酒者>32%，CART组和NART组之间无统计学差异。肺炎链球菌是最常见的病原体（60%）。NART组达到临床稳定的时间显著长于CART组（p = 0.011）。多变量分析中，美国疾病控制与预防中心（CDC）C期、CD4细胞计数<100×10⁶个/升以及肺炎链球菌病因是临床稳定时间>7天的预测因素，而接受抗逆转录病毒治疗具有保护作用。CART组和NART组的死亡百分比无差异；大多数患者CD4计数<200×10⁶个/升或伴有严重的合并症。

结论

在本研究中观察到的HIV感染住院患者中BCAP发病率较高，主要原因是HIV感染本身、注射吸毒、酗酒和吸烟习惯。临床稳定时间较长与晚期HIV感染及肺炎链球菌病因相关，而接受抗逆转录病毒治疗具有保护作用。应实施注射吸毒治疗、酗酒和戒烟项目、抗逆转录病毒治疗依从性支持以及肺炎球菌疫苗接种，以降低HIV感染患者中BCAP的发病率并改善其预后。