Messiaen Peter E, Cuyx Senne, Dejagere Tom, van der Hilst Jeroen C
Department of Infectious Diseases and Immunity, Jessa Hospital, Hasselt, Belgium.
Biomedical Research Institute BIOMED, Hasselt University, Hasselt, Belgium.
Transpl Infect Dis. 2017 Apr;19(2). doi: 10.1111/tid.12651. Epub 2017 Feb 15.
In recent years, the incidence of Pneumocystis jirovecii pneumonia (PJP) has increased in immunocompromised patients without human immunodeficiency virus (HIV) infection. Chemoprophylaxis with trimethoprim-sulfamethoxazole (TMP-SMX) is highly effective in preventing PJP in both HIV-positive and -seronegative patients. In HIV-positive patients, the risk of PJP is strongly correlated with decreased CD4 cell count. The role of CD4 cell count in the pathogenesis of PJP in non-HIV immunocompromised patients is less well studied. For most immunosuppressive conditions, no clear guidelines indicate whether to start TMP-SMX.
We conducted a systematic literature review with the aim to provide a comprehensive overview on the role of CD4 cell counts in managing the risk of PJP in HIV-seronegative patients.
Of the 63 individual studies retrieved, 14 studies report on CD4 cell counts in a variety of immunosuppressive conditions. CD4 cell count were <200/μL in 73.1% of the patients.
CD4 cell count <200/μL is a sensitive biomarker to identify non-HIV immunocompromised patients who are at risk for PJP. Measuring CD4 cell counts could help clinicians identify patients who may benefit from TMP-SMX prophylaxis.
近年来，在无人类免疫缺陷病毒（HIV）感染的免疫功能低下患者中，耶氏肺孢子菌肺炎（PJP）的发病率有所上升。用甲氧苄啶-磺胺甲恶唑（TMP-SMX）进行化学预防在预防HIV阳性和血清阴性患者的PJP方面都非常有效。在HIV阳性患者中，PJP的风险与CD4细胞计数降低密切相关。CD4细胞计数在非HIV免疫功能低下患者PJP发病机制中的作用研究较少。对于大多数免疫抑制情况，没有明确的指南表明是否应开始使用TMP-SMX。
我们进行了一项系统的文献综述，旨在全面概述CD4细胞计数在管理HIV血清阴性患者PJP风险中的作用。
在检索到的63项个体研究中，有14项研究报告了各种免疫抑制情况下的CD4细胞计数。73.1%的患者CD4细胞计数<200/μL。
CD4细胞计数<200/μL是识别有PJP风险的非HIV免疫功能低下患者的敏感生物标志物。检测CD4细胞计数有助于临床医生识别可能从TMP-SMX预防中获益的患者。
