Unidad de Enfermedades Infecciosas, Hospital La Fe, Valencia, Spain.
Enferm Infecc Microbiol Clin. 2012 Dec;30(10):608-12. doi: 10.1016/j.eimc.2012.02.007. Epub 2012 Mar 28.
To determine the clinical, epidemiological and prognostic factors of HIV-infected patients with influenza A H1N1 admitted to hospital.
The study population was HIV infected patients with confirmed influenza infection admitted to hospital in a multicenter cohort. We analyzed demographic data, comorbid conditions, severe events (bronchopneumonia, respiratory insufficiency, respiratory distress, sepsis, admission to intensive care unit, death) and outcome. Data were analyzed using descriptive statistics. Proportions were compared using the χ(2) test or Fisher exact test, when applicable. Quantitative variables were compared using the Student t test or Mann-Whitney test. Prognostic impact was analyzed using logistic regression.
A total of 43 patients, of whom 62.8% were male, were included from 22 hospitals. The mean age was 43.3 years (interquartile range [IQR], 38.4-48.4). HIV was diagnosed for a mean of 14.5 years (IQR, 8.4-20.3). CD4 lymphocyte was <200 cells/μL in 38%; 85.7% were on antiretroviral therapy, and 66.7% virologically suppressed. Comorbid conditions were hepatitis B or C (74.4%), smoking (67.4%), chronic obstructive pulmonary disease (30.2%), asthma (14%), and obesity (8.6%). Seven patients had received seasonal influenza vaccination, and 2 the H1N1 vaccine. Cough (100%), fever (93%), gastrointestinal disorders (27.9%) or general--myalgia, general malaise--(67.4%) were the presenting symptoms. These were severe in 24 (55.8%) with 7 (16.3%) requiring intensive care. Two patients died. A lower CD4 lymphocyte count was associated with bacterial infection (P=.063) and longer hospital stay (P=.007). Early oseltamivir reduced severe cases (OR, 4.5; 1.1-18.3; P=.035).
HIV-infected patients admitted to hospital due to influenza A H1N1 had severe morbidity. Low CD4 lymphocytes correlated with longer hospitalization and bacterial infections. Early oseltamivir treatment reduced severe symptoms.
确定感染 HIV 的甲型 H1N1 流感患者住院的临床、流行病学和预后因素。
本研究纳入了在多中心队列中因确诊流感感染而住院的 HIV 感染患者。我们分析了人口统计学数据、合并症、严重事件（支气管肺炎、呼吸功能不全、呼吸窘迫、败血症、入住重症监护病房、死亡）和结局。采用描述性统计分析数据。应用卡方检验或 Fisher 确切概率法比较比例，应用学生 t 检验或 Mann-Whitney U 检验比较定量变量。应用 logistic 回归分析预后影响。
共纳入来自 22 家医院的 43 例患者，其中 62.8%为男性，平均年龄为 43.3 岁（四分位间距 [IQR]，38.4-48.4）。HIV 诊断的平均时间为 14.5 年（IQR，8.4-20.3）。38%的患者 CD4 淋巴细胞<200 个/μL；85.7%正在接受抗逆转录病毒治疗，66.7%病毒学抑制。合并症包括乙型或丙型肝炎（74.4%）、吸烟（67.4%）、慢性阻塞性肺疾病（30.2%）、哮喘（14%）和肥胖症（8.6%）。7 例患者接种了季节性流感疫苗，2 例接种了 H1N1 疫苗。100%的患者出现咳嗽，93%的患者出现发热，27.9%的患者出现胃肠道疾病或全身症状（肌痛、全身不适）。24 例（55.8%）患者的症状严重，其中 7 例（16.3%）需要入住重症监护病房。2 例患者死亡。较低的 CD4 淋巴细胞计数与细菌感染（P=.063）和较长的住院时间（P=.007）相关。早期奥司他韦治疗降低了严重病例的发生率（OR，4.5；1.1-18.3；P=.035）。
因甲型 H1N1 流感住院的 HIV 感染患者病情严重。较低的 CD4 淋巴细胞与较长的住院时间和细菌感染相关。早期奥司他韦治疗可降低严重症状的发生率。
