Center for Research in Infectious Diseases, National Institute of Respiratory Diseases, Mexico City, Mexico.
AIDS. 2011 Feb 20;25(4):435-9. doi: 10.1097/QAD.0b013e3283434844.
To describe the clinical course of infection by 2009 (H1N1) influenza virus in different stages of HIV disease.
Prospective, observational study.
During the pandemic period, HIV-infected patients presenting respiratory symptoms at a third level referral hospital in Mexico City were tested for 2009 influenza A (H1N1) viral RNA. Clinical files were prospectively analyzed.
Infection by H1N1 was confirmed in 30 (23.8%) of the total 126 HIV-infected patients studied. In the group of patients with 2009 H1N1 virus infection, 16 (53.3%) were hospitalized, 12 (40%) had active opportunistic infections and six (20%) died. In the group of 96 patients not infected with 2009 H1N1 virus, 54 (56.25%) were hospitalized with opportunistic infections and 12 (12.5%) died. For all hospitalized patients, being on HAART and having undetectable HIV viral loads at hospitalization was associated with higher survival (P = 0.019). Patients with 2009 H1N1 virus infection had a higher mortality rate, even after adjusting for HAART (P = 0.043). Coinfection by HIV and H1N1 2009 virus was more severe in patients with opportunistic infections, as shown by longer hospital stays (P = 0.0013), higher rates of hospitalization (P < 0.0001), use of mechanical ventilation (P = 0.0086) and death (P = 0.026). Delayed administration of oseltamivir in hospitalized patients was significantly associated with mortality (P = 0.0022).
Our data suggest that infection by 2009 H1N1 is more severe in HIV-infected patients with late and advanced HIV disease than in well controlled patients under HAART.
描述感染 2009 年（H1N1）流感病毒在不同阶段 HIV 疾病中的临床过程。
前瞻性、观察性研究。
在大流行期间，墨西哥城三级转诊医院出现呼吸道症状的 HIV 感染患者接受了 2009 年甲型流感（H1N1）病毒 RNA 检测。前瞻性分析临床档案。
在研究的 126 例 HIV 感染患者中，共确诊感染 H1N1 30 例（23.8%）。在感染 2009 年 H1N1 病毒的患者组中，16 例（53.3%）住院，12 例（40%）患有活动性机会性感染，6 例（20%）死亡。在未感染 2009 年 H1N1 病毒的 96 例患者组中，54 例（56.25%）因机会性感染住院，12 例（12.5%）死亡。对于所有住院患者，住院时接受 HAART 治疗且 HIV 病毒载量无法检测与更高的生存率相关（P=0.019）。即使调整了 HAART，感染 2009 年 H1N1 病毒的患者死亡率仍较高（P=0.043）。HIV 和 2009 年 H1N1 病毒的合并感染在患有机会性感染的患者中更为严重，表现为住院时间延长（P=0.0013）、住院率更高（P<0.0001）、机械通气使用率（P=0.0086）和死亡率（P=0.026）更高。住院患者奥司他韦延迟给药与死亡率显著相关（P=0.0022）。
我们的数据表明，与接受 HAART 良好控制的患者相比，晚期和晚期 HIV 疾病的 HIV 感染患者感染 2009 年 H1N1 更为严重。
