Mayo Clinic College of Medicine, Rochester, MN, USA.
Inserm CIC 1424, Centre d'Investigation Clinique Antilles Guyane, Centre Hospitalier de Cayenne, Cayenne, France; Equipe EA 3593, Ecosystèmes Amazoniens et Pathologie Tropicale, Université de Guyane, Cayenne, France.
Lancet Infect Dis. 2017 Nov;17(11):e334-e343. doi: 10.1016/S1473-3099(17)30303-1. Epub 2017 Jul 31.
Fungi are major contributors to the opportunistic infections that affect patients with HIV/AIDS. Systemic infections are mainly with Pneumocystis jirovecii (pneumocystosis), Cryptococcus neoformans (cryptococcosis), Histoplasma capsulatum (histoplasmosis), and Talaromyces (Penicillium) marneffei (talaromycosis). The incidence of systemic fungal infections has decreased in people with HIV in high-income countries because of the widespread availability of antiretroviral drugs and early testing for HIV. However, in many areas with high HIV prevalence, patients present to care with advanced HIV infection and with a low CD4 cell count or re-present with persistent low CD4 cell counts because of poor adherence, resistance to antiretroviral drugs, or both. Affordable, rapid point-of-care diagnostic tests (as have been developed for cryptococcosis) are urgently needed for pneumocystosis, talaromycosis, and histoplasmosis. Additionally, antifungal drugs, including amphotericin B, liposomal amphotericin B, and flucytosine, need to be much more widely available. Such measures, together with continued international efforts in education and training in the management of fungal disease, have the potential to improve patient outcomes substantially.
真菌是导致 HIV/AIDS 患者发生机会性感染的主要因素。系统性真菌感染主要由卡氏肺孢子虫（肺孢子菌病）、新生隐球菌（隐球菌病）、荚膜组织胞浆菌（组织胞浆菌病）和土曲霉（青霉菌）马尔尼菲青霉（马尔尼菲青霉病）引起。由于抗逆转录病毒药物的广泛应用和 HIV 的早期检测，高收入国家 HIV 感染者中系统性真菌感染的发病率有所下降。然而，在许多 HIV 高发地区，由于患者的 HIV 感染较为严重，CD4 细胞计数较低，或因药物依从性差、对抗逆转录病毒药物耐药或两者兼而有之，导致 CD4 细胞计数持续较低，患者在就诊时已经处于晚期。迫切需要针对肺孢子菌病、马尔尼菲青霉病和荚膜组织胞浆菌病开发经济实惠、快速的床边诊断检测方法（已经开发出针对隐球菌病的检测方法）。此外，还需要更广泛地获得两性霉素 B、脂质体两性霉素 B 和氟胞嘧啶等抗真菌药物。这些措施，以及在真菌病管理方面持续开展的国际教育和培训工作，有可能大大改善患者的预后。
