Munier Anne-Lise, de Lastours Victoire, Porcher Raphaël, Donay Jean-Luc, Pons Jean-Louis, Molina Jean-Michel
Infectious Diseases Department, St Louis Hospital, APHP and University Paris Diderot, Paris, France
Infectious Diseases Department, St Louis Hospital, APHP and University Paris Diderot, Paris, France.
Int J STD AIDS. 2014 Dec;25(14):1022-8. doi: 10.1177/0956462414528316. Epub 2014 Mar 27.
Invasive pneumococcal diseases remain frequent and severe in HIV-infected subjects. To identify opportunities for prevention, we assessed risk factors of invasive pneumococcal diseases (IPD) in HIV-infected patients over a 10-year period in France. We performed a retrospective case-control study in a reference centre of HIV management in Paris. All HIV-infected patients having suffered from IPD between 2000 and 2011 were included. Control subjects were HIV-infected with no history of IPD or pneumonia, matched by date of diagnosis of HIV with controls. Two controls were randomly selected for each subject. In all, 42 HIV-infected patients presented 44 IPD episodes during the study period and were compared to 84 controls. In the multivariate analysis, patients with IPD were more likely than controls to have a Charlson Comorbidity Index ≥2 (adjusted OR = 7.07, 95% CI 1.99-25.1, p = 0.003), CD4-cell count <200/cells/µL (aOR = 6.93, 95% CI 1.80-26.7, p = 0.005), HIV-RNA viral load >400 copies/mL (aOR = 5.56, 95% CI 1.58-19.5, p = 0.007) and a non-European origin (aOR = 4.26, 95% CI 1.02-17.9, p = 0.047). HIV-infected patients with a higher burden of comorbidities, uncontrolled HIV replication, low CD4-cell counts and/or of non-European origin are at higher risk of developing IPD. Better screening for and management of HIV infection is necessary to reduce the risk of IPD.
侵袭性肺炎球菌疾病在HIV感染患者中仍然常见且严重。为了确定预防机会，我们评估了法国10年间HIV感染患者侵袭性肺炎球菌疾病（IPD）的危险因素。我们在巴黎一家HIV管理参考中心进行了一项回顾性病例对照研究。纳入了2000年至2011年间所有患IPD的HIV感染患者。对照对象为无IPD或肺炎病史的HIV感染者，按HIV诊断日期与病例匹配。为每个病例随机选取两名对照。在研究期间，共有42例HIV感染患者出现44次IPD发作，并与84名对照进行比较。在多变量分析中，IPD患者比对照更有可能具有Charlson合并症指数≥2（调整后OR = 7.07，95%CI 1.99 - 25.1，p = 0.003）、CD4细胞计数<200/细胞/µL（aOR = 6.93，95%CI 1.80 - 26.7，p = 0.005）、HIV-RNA病毒载量>400拷贝/mL（aOR = 5.56，95%CI 1.58 - 19.5，p = 0.007）以及非欧洲血统（aOR = 4.26，95%CI 1.02 - 17.9，p = 0.047）。合并症负担较高、HIV复制未得到控制、CD4细胞计数低和/或非欧洲血统的HIV感染患者发生IPD的风险更高。更好地筛查和管理HIV感染对于降低IPD风险是必要的。
