Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Avenida Brasil 4365-Manguinhos, Rio de Janeiro, RJ, CEP 21.040-900, Brazil.
Universidade do Grande Rio, Rio de Janeiro, Brazil.
Infection. 2017 Dec;45(6):801-809. doi: 10.1007/s15010-017-1041-0. Epub 2017 Jun 28.
Community-acquired pneumonia represents the most frequent bacterial infection in patients with HIV/AIDS.
We aimed to assess variables associated with lower respiratory tract infection (LRTI) among HIV-infected adults using ART.
A cohort study of HIV-infected patients aged ≥18 years, enrolled from 2000 to 2015, on ART for at least 60 days, with primary outcome as the 1st episode of LRTI during follow-up. The independent variables included were sex at birth, age, race/skin color, educational level, tobacco smoking, alcohol use, cocaine use, diabetes mellitus, CD4 count, HIV viral load, influenza and pneumococcal vaccination. Extended Cox proportional hazards models accounting for time-updated variables were fitted to assess LRTI predictors.
2669 patients were included; median follow-up was 3.9 years per patient. LRTI was diagnosed in 384 patients; incidence rate was 30.7/1000 PY. In the unadjusted Cox extended models, non-white race [crude hazard ratio (cHR) 1.28, p = 0.020], cocaine use (cHR 2.01, p < 0.001), tobacco smoking (cHR 1.34, p value 0.007), and HIV viral load ≥400 copies/mL (cHR 3.40, p < 0.001) increased the risk of LRTI. Lower risk of LRTI was seen with higher educational level (cHR 0.61, p < 0.001), rise in CD4 counts (cHR 0.81, p < 0.001, per 100 cells/mm increase), influenza (cHR 0.60, p = 0.002) and pneumococcal vaccination (cHR 0.57, p < 0.001). In the adjusted model, aHR for CD4 count was 0.86, for cocaine use 1.47 and for viral load ≥400 copies 2.20.
LRTI has a high incidence in HIV-infected adults using ART. Higher CD4 counts and undetectable viral loads were protective, as were pneumococcal and influenza vaccines.
非艾滋病相关性肺炎是艾滋病病毒（HIV）感染者最常见的细菌感染。
我们旨在评估接受抗逆转录病毒治疗（ART）的 HIV 感染者中与下呼吸道感染（LRTI）相关的变量。
这是一项队列研究，纳入了 2000 年至 2015 年间年龄≥18 岁、接受 ART 治疗至少 60 天、随访期间首次发生 LRTI 的 HIV 感染者。独立变量包括出生时的性别、年龄、种族/肤色、教育程度、吸烟、饮酒、可卡因使用、糖尿病、CD4 计数、HIV 病毒载量、流感和肺炎球菌疫苗接种。拟合了考虑时间更新变量的扩展 Cox 比例风险模型，以评估 LRTI 的预测因素。
共纳入 2669 例患者，中位随访时间为每位患者 3.9 年。384 例患者诊断为 LRTI，发病率为 30.7/1000 人年。在未经调整的 Cox 扩展模型中，非白色人种[粗危险比（cHR）1.28，p=0.020]、可卡因使用（cHR 2.01，p<0.001）、吸烟（cHR 1.34，p 值 0.007）和 HIV 病毒载量≥400 拷贝/ml（cHR 3.40，p<0.001）增加了 LRTI 的风险。较高的教育水平（cHR 0.61，p<0.001）、CD4 计数升高（cHR 0.81，p<0.001，每增加 100 个细胞/mm）、流感（cHR 0.60，p=0.002）和肺炎球菌疫苗接种（cHR 0.57，p<0.001）可降低 LRTI 的风险。在调整模型中，CD4 计数的调整后危险比（aHR）为 0.86，可卡因使用的 aHR 为 1.47，病毒载量≥400 拷贝的 aHR 为 2.20。
接受抗逆转录病毒治疗的 HIV 感染者中，LRTI 的发病率很高。较高的 CD4 计数和不可检测的病毒载量具有保护作用，肺炎球菌和流感疫苗也是如此。
