高活性抗逆转录病毒疗法时代南非儿童中人类免疫缺陷病毒感染与非感染患者的肺囊虫肺炎。

Pneumocystis pneumonia in South African children with and without human immunodeficiency virus infection in the era of highly active antiretroviral therapy.

机构信息

Department of Paediatics and Child Health, University of Cape Town, Cape Town, South Africa.

出版信息

Pediatr Infect Dis J. 2010 Jun;29(6):535-9. doi: 10.1097/INF.0b013e3181ce871e.

DOI:10.1097/INF.0b013e3181ce871e

PMID:20072079

Abstract

BACKGROUND

Pneumocystis pneumonia (PCP) is a major cause of hospitalization and mortality in human immunodeficiency virus (HIV)-infected African children.

AIM

The aim of this study was to investigate the incidence and outcome of PCP in South African children living in a high HIV-prevalence area in the context of a free, available antiretroviral therapy program.

METHODS

Sequential children hospitalized with hypoxic pneumonia were prospectively enrolled from November 2006 to August 2008. Sociodemographic, historical, clinical, and outcome data were collected. A nasopharyngeal aspirate and lower respiratory tract sample (induced sputum or bronchoalveolar lavage) were submitted for PCP immunofluorescence. Lower respiratory tract samples were also investigated for bacterial, mycobacterial, and viral pathogens.

RESULTS

A total of 202 children were enrolled; 124 (61.4%) were HIV-infected; 34 (16.8%) were HIV-exposed but uninfected and 44 (21.8%) were HIV-unexposed. Among HIV-exposed children, 70 (44.3%) had participated in the Prevention of Mother to Child Transmission program, but only 18.4% were taking trimethoprim-sulfamethoxazole prophylaxis. PCP occurred in 43 children (21.3%) of whom 33 (76.7%) were HIV-infected. The case fatality of children with PCP was higher than those without PCP (39.5% vs. 21.4%; relative risk, 1.85; 95% confidence interval, 1.15-2.97; P = 0.01).

CONCLUSIONS

PCP is a common cause of hypoxic pneumonia and mortality in HIV-infected South African infants. Underuse of the Prevention of Mother to Child Transmission program and failure to institute trimethoprim-sulfamethoxazole prophylaxis in HIV-exposed children identified through the program are important obstacles to reducing PCP incidence.

摘要

背景

肺囊虫肺炎（PCP）是导致感染人类免疫缺陷病毒（HIV）的非洲儿童住院和死亡的主要原因。

目的

本研究旨在调查在提供免费抗逆转录病毒治疗方案的情况下，南非高 HIV 流行地区儿童中 PCP 的发病率和结局。

方法

2006 年 11 月至 2008 年 8 月，连续前瞻性纳入因低氧性肺炎住院的儿童。收集社会人口统计学、病史、临床和结局数据。采集鼻咽抽吸物和下呼吸道样本（诱导痰或支气管肺泡灌洗）进行 PCP 免疫荧光检测。还对下呼吸道样本进行细菌、分枝杆菌和病毒病原体检测。

结果

共纳入 202 例儿童；124 例（61.4%）为 HIV 感染者；34 例（16.8%）为 HIV 暴露但未感染，44 例（21.8%）为 HIV 未暴露。在 HIV 暴露儿童中，70 例（44.3%）参加了母婴传播预防计划，但仅有 18.4%接受了复方磺胺甲噁唑预防。43 例（21.3%）儿童发生 PCP，其中 33 例（76.7%）为 HIV 感染者。PCP 患儿的病死率高于无 PCP 患儿（39.5%比 21.4%；相对危险度，1.85；95%置信区间，1.15-2.97；P=0.01）。