抗逆转录病毒治疗（HAART）时代末期 HIV 感染者住院的趋势和原因：CD4 计数和 HAART 使用的影响如何？
Trends and causes of hospitalizations among HIV-infected persons during the late HAART era: what is the impact of CD4 counts and HAART use?
机构信息
Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
出版信息
J Acquir Immune Defic Syndr. 2010 Jul;54(3):248-57. doi: 10.1097/qai.0b013e3181c8ef22.
BACKGROUND
Declining rates of hospitalizations occurred shortly after the availability of highly active antiretroviral therapy (HAART). However, trends in the late HAART era are less defined, and data on the impact of CD4 counts and HAART use on hospitalizations are needed.
METHODS
We evaluated hospitalization rates from 1999 to 2007 among HIV-infected persons enrolled in a large US military cohort. Poisson regression was used to compare hospitalization rates per year and to examine factors associated with hospitalization.
RESULTS
Of the 2429 participants, 822 (34%) were hospitalized at least once with 1770 separate hospital admissions. The rate of hospitalizations (137 per 1000 person-years) was constant over the study period [relative rate (RR) 1.00 per year change, 95% confidence interval: 0.98 to 1.02]. The hospitalization rates due to skin infections (RR: 1.50, P = 0.02), methicillin-resistant staphylococcus aureus (RR: 3.19, P = 0.03), liver disease (RR: 1.71, P = 0.04), and surgery (RR: 1.17, P = 0.04) significantly increased over time, whereas psychological causes (RR: 0.60, P < 0.01) and trauma (RR: 0.54, P < 0.01) decreased. In the multivariate model, higher nadir CD4 (RR: 0.92 per 50 cells, P < 0.01) and higher proximal CD4 counts (RR of 0.71 for 350-499 vs. <350 cells/mm(3) and RR 0.67 for > or = 500 vs. 350 cells/mm(3), both P < 0.01) were associated with lower risk of hospitalization. Risk of hospitalization was constant for proximal CD4 levels above 350 (RR: 0.94 P = 0.51, CD4 > or = 500 vs. 350-499). HAART was associated with a reduced risk of hospitalization among those with a CD4 <350 (RR: 0.72, P = 0.02) but had smaller estimated and nonsignificant effects at higher CD4 levels (RR: 0.81, P = 0.33 and 1.06, P = 0.71 for CD4 350-499 and > or = 500, respectively).
CONCLUSIONS
Hospitalizations continue to occur at high rates among HIV-infected persons with increasing rates for skin infections, methicillin-resistant staphylococcus aureus, liver disease, and surgeries. Factors associated with a reduced risk of hospitalization include CD4 counts >350 cells per cubic millimeter and HAART use among patients with a CD4 count <350 cells per cubic millimeter.
背景
高效抗逆转录病毒疗法（HAART）问世后不久，住院率就开始下降。然而，在 HAART 后期时代的趋势不太明确，并且需要有关 CD4 计数和 HAART 使用对住院的影响的数据。
方法
我们评估了在一项大型美国军事队列中感染 HIV 的人群中，1999 年至 2007 年期间的住院率。泊松回归用于比较每年的住院率，并研究与住院相关的因素。
结果
在 2429 名参与者中，有 822 名（34％）至少住院一次，有 1770 次单独的住院治疗。研究期间的住院率（每 1000 人年 137 例）保持不变[相对危险度（RR）每年变化 1.00，95％置信区间：0.98 至 1.02]。皮肤感染（RR：1.50，P = 0.02），耐甲氧西林金黄色葡萄球菌（RR：3.19，P = 0.03），肝病（RR：1.71，P = 0.04）和手术（RR：1.17，P = 0.04）的住院率随着时间的推移而显着增加，而心理原因（RR：0.60，P <0.01）和创伤（RR：0.54，P <0.01）则减少。在多变量模型中，较低的 CD4 最低点（RR：每 50 个细胞 0.92，P <0.01）和较高的近端 CD4 计数（RR 为 350-499 与 <350 细胞/mm（3）和 RR 为 0.67 相比，为 >或= 500 与 350 细胞/mm（3），均 P <0.01）与较低的住院风险相关。近端 CD4 水平高于 350 时，住院风险保持不变（RR：0.94 P = 0.51，CD4 >或= 500 vs. 350-499）。在 CD4 <350 的患者中，HAART 与降低住院风险相关（RR：0.72，P = 0.02），但在 CD4 水平较高时，估计效果较小且无统计学意义（RR：0.81，P = 0.33 和 1.06，P = 0.71 分别为 CD4 350-499 和 >或= 500）。
结论
随着皮肤感染，耐甲氧西林金黄色葡萄球菌，肝病和手术住院率的增加，HIV 感染者的住院率仍持续居高不下。与降低住院风险相关的因素包括 CD4 计数> 350 个细胞/立方毫米和 CD4 计数<350 个细胞/立方毫米的患者使用 HAART。
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