Lesourd Anaïs, Leporrier Jérémie, Delbos Valérie, Unal Guillemette, Honoré Patricia, Etienne Manuel, Bouchaud Olivier, Caron François
Centre Hospitalo-Universitaire Charles Nicolle, Service de Maladies Infectieuses et Tropicales , Rouen, France.
Centre Hospitalo-Universitaire Charles Nicolle, Service de Maladies Infectieuses et Tropicales, Rouen, France;; Groupe de Recherche sur l'Adaptation Microbienne (2.0-EA 2656, Institut de Recherche et d'Innovation Biomédicale), Normandie Université, Rouen, France.
Open Forum Infect Dis. 2016 Dec 20;3(4):ofw228. doi: 10.1093/ofid/ofw228. eCollection 2016 Oct.
Despite antiretroviral therapy, it is generally believed that the risk for pneumococcal infections (PnIs) is high among patients infected with human immunodeficiency virus (HIV). However, most studies in this field have been conducted before 2010, and the proportion of virologically suppressed patients has drastically increased in these latter years thanks to larger indications and more effective antiretroviral regimens. This study aimed to re-evaluate the current risk of PnI among adult patients infected with HIV.
The incidence of PnI was evaluated between 1996 and 2014 in 2 French regional hospitals. The 80 most recent cases of PnI (2000-2014) were retrospectively compared with 160 controls (HIV patients without PnI) to analyze the residual risk factors of PnI.
Among a mean annual follow-up cohort of 1616 patients, 116 PnIs were observed over 18 years. The risk factors of PnI among patients infected with HIV were an uncontrolled HIV infection or "classic" risk factors of PnI shared by the general population such as addiction, renal or respiratory insufficiency, or hepatitis B or C coinfection. Pneumococcal vaccination coverage was low and poorly targeted, because only 5% of the cases had been previously vaccinated. The incidence of invasive PnIs among HIV patients with a nonvirologically suppressed infection or comorbidities was 12 times higher than that reported in the general population at the country level (107 vs 9/100000 patients), whereas the incidence among virologically suppressed HIV patients without comorbidities was lower (7.6/100000 patients).
Human immunodeficiency virus infection no longer per se seems to be a significant risk factor for PnI, suggesting a step-down from a systematic to an "at-risk patient" targeted pneumococcal vaccination strategy.
尽管有抗逆转录病毒疗法，但人们普遍认为，感染人类免疫缺陷病毒（HIV）的患者发生肺炎球菌感染（PnI）的风险很高。然而，该领域的大多数研究是在2010年之前进行的，近年来，由于适应症扩大和抗逆转录病毒治疗方案更有效，病毒学抑制患者的比例大幅增加。本研究旨在重新评估成年HIV感染患者目前发生PnI的风险。
在法国两家地区医院评估了1996年至2014年期间PnI的发病率。回顾性比较了最近80例PnI病例（2000 - 2014年）与160例对照（无PnI的HIV患者），以分析PnI的残留风险因素。
在平均每年随访1616例患者的队列中，18年间观察到116例PnI。HIV感染患者发生PnI的风险因素是HIV感染未得到控制，或一般人群共有的PnI“经典”风险因素，如成瘾、肾或呼吸功能不全，或乙型或丙型肝炎合并感染。肺炎球菌疫苗接种覆盖率低且针对性差，因为只有5%的病例之前接种过疫苗。未实现病毒学抑制的感染或合并症的HIV患者中侵袭性PnI的发病率比国家层面一般人群报告的发病率高12倍（107例/100000例患者对9例/100000例患者），而无合并症的病毒学抑制HIV患者的发病率较低（7.6例/100000例患者）。
人类免疫缺陷病毒感染本身似乎不再是PnI的重要风险因素，这表明肺炎球菌疫苗接种策略应从系统性接种转向针对“高危患者”的接种。
