INSERM, U897, CIC-EC7, Bordeaux, France.
PLoS One. 2010 Jan 26;5(1):e8896. doi: 10.1371/journal.pone.0008896.
Bacterial pneumonia is still a substantial cause of morbidity and mortality in HIV-infected patients in the era of combination Antiretroviral Therapy. The benefit of tobacco withdrawal on the risk of bacterial pneumonia has not been quantified in such populations, exposed to other important risk factors such as HIV-related immunodeficiency. Our objective was to estimate the effect of tobacco smoking withdrawal on the risk of bacterial pneumonia among HIV-infected individuals.
METHODOLOGY/PRINCIPAL FINDINGS: Patients of the ANRS CO3 Aquitaine Cohort with >or= two visits during 2000-2007 and without bacterial pneumonia at the first visit were included. Former smokers were patients who stopped smoking since >or= one year. We used Cox proportional hazards models adjusted on CD4+ lymphocytes (CD4), gender, age, HIV transmission category, antiretroviral therapy, cotrimoxazole prophylaxis, statin treatment, viral load and previous AIDS diagnosis. 135 cases of bacterial pneumonia were reported in 3336 patients, yielding an incidence of 12 per thousand patient-years. The adjusted hazard of bacterial pneumonia was lower in former smokers (Hazard Ratio (HR): 0.48; P = 0.02) and never smokers (HR: 0.50; P = 0.01) compared to current smokers. It was higher in patients with <200 CD4 cells/microL and in those with 200 to 349 CD4 cells/microL (HR: 2.98 and 1.98, respectively; both P<0.01), but not in those with 350 to 499 CD4 cells/microL (HR: 0.93; P = 0.79), compared to those with >or=500 CD4 cells/microL. The interaction between CD4 cell count and tobacco smoking status was not statistically significant.
CONCLUSIONS/SIGNIFICANCE: Smoking cessation dramatically reduces the risk of bacterial pneumonia, whatever the level of immunodeficiency. Smoking cessation interventions should become a key element of the clinical management of HIV-infected individuals.
在接受联合抗逆转录病毒治疗的时代，细菌性肺炎仍然是 HIV 感染者发病率和死亡率的重要原因。在这些人群中，尚未对戒烟对细菌性肺炎风险的益处进行量化，而这些人群还面临着其他重要的危险因素，如与 HIV 相关的免疫缺陷。我们的目的是估计 HIV 感染者戒烟对细菌性肺炎风险的影响。
方法/主要发现：纳入了在 2000-2007 年期间有>或=两次就诊且第一次就诊时无细菌性肺炎的 ANRS CO3 阿基坦队列患者。曾经吸烟者是指自>或=一年前停止吸烟的患者。我们使用 Cox 比例风险模型进行调整，模型调整了 CD4+淋巴细胞（CD4）、性别、年龄、HIV 传播途径、抗逆转录病毒治疗、复方磺胺甲噁唑预防、他汀类药物治疗、病毒载量和既往 AIDS 诊断。在 3336 例患者中，报告了 135 例细菌性肺炎，发病率为每千患者年 12 例。与当前吸烟者相比，曾经吸烟者（风险比（HR）：0.48；P = 0.02）和从不吸烟者（HR：0.50；P = 0.01）发生细菌性肺炎的调整后风险较低。与 CD4 细胞<200 个/μL 和 200-349 个/μL 的患者相比（HR：2.98 和 1.98，均 P<0.01），与 CD4 细胞>或=500 个/μL 的患者相比，风险更高（HR：0.93；P = 0.79）。CD4 细胞计数与吸烟状况之间的交互作用无统计学意义。
结论/意义：无论免疫缺陷程度如何，戒烟都能显著降低细菌性肺炎的风险。戒烟干预措施应成为 HIV 感染者临床管理的关键要素。
