Division of Hematology-Oncology, University of Pittsburgh Medical Center Shadyside Hospital, Pennsylvania.
Division of Hematology-Oncology, University of Pittsburgh School of Medicine, Pennsylvania.
Clin Infect Dis. 2018 Jun 18;67(1):128-133. doi: 10.1093/cid/ciy010.
Prior studies have shown that outcomes of hematopoietic stem cell transplantation (HSCT) in human immunodeficiency virus (HIV)-positive patients have been similar to outcomes in HIV-negative patients since effective implementation of highly active antiretroviral therapy by 1998, but they are limited by small sample size or noninclusion of recent data.
We queried National Inpatient Sample, a large inpatient data set in the United States, from 1998 to 2012 for HSCT, using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) procedure code 41.0. HIV-positive patients were identified by the presence of ICD-9-CM diagnostic codes 042, 043, 044, V08, and 079.53. The primary outcome was in-hospital mortality rate, and the secondary outcome the in-hospital complication rate of HSCT. Outcomes were assessed by means of univariate, multivariate regression and matched-pair analysis.
A total of 39517 patients who underwent HSCT were identified. Among these, 108 patients had HIV infection. There were no differences in in-hospital mortality rates or rates of intubation, sepsis, bacteremia, or graft-vs-host disease between HIV-positive and HIV-negative patients after allogeneic or autologous HSCT. In allogeneic HSCT, HIV-positive patients had a significantly higher incidence of nontuberculous mycobacterial and cytomegalovirus infection than HIV-negative patients.
Although HIV-positive patients may have a higher risk of certain opportunistic infections, they are not at higher risk of serious in-hospital complications of HSCT. Allogeneic and autologous HSCT can be safely performed in HIV-positive patients.
自 1998 年高效抗逆转录病毒疗法有效实施以来，先前的研究表明，艾滋病毒（HIV）阳性患者的造血干细胞移植（HSCT）结果与 HIV 阴性患者相似，但这些研究受到样本量小或未纳入最新数据的限制。
我们在美国的大型住院患者数据集 National Inpatient Sample 中，从 1998 年至 2012 年，使用国际疾病分类，第九修订版，临床修正（ICD-9-CM）程序代码 41.0 对 HSCT 进行了查询。通过存在 ICD-9-CM 诊断代码 042、043、044、V08 和 079.53 来识别 HIV 阳性患者。主要结果是住院死亡率，次要结果是 HSCT 的住院并发症发生率。通过单变量、多变量回归和配对分析来评估结果。
共确定了 39517 例接受 HSCT 的患者。其中，有 108 例患者感染了 HIV。异基因或自体 HSCT 后，HIV 阳性和 HIV 阴性患者的住院死亡率或插管、败血症、菌血症或移植物抗宿主病发生率没有差异。在异基因 HSCT 中，HIV 阳性患者比 HIV 阴性患者发生非结核分枝杆菌和巨细胞病毒感染的风险显著更高。
尽管 HIV 阳性患者可能有更高的某些机会性感染风险，但他们 HSCT 的严重住院并发症风险并不更高。可以安全地在 HIV 阳性患者中进行异基因和自体 HSCT。
