a Department of Pulmonary Medicine Institut Clinic del Tórax, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) , University of Barcelona (UB) - SGR 911- Ciber de Enfermedades Respiratorias (Ciberes) , Barcelona , Spain.
b Infectious Diseases Service, Hospital Clinic-IDIBAPS , University of Barcelona , Barcelona , Spain.
Expert Rev Anti Infect Ther. 2018 Jul;16(7):579-588. doi: 10.1080/14787210.2018.1495560. Epub 2018 Jul 12.
Despite active antiretroviral therapy (ART), community-acquired pneumonia (CAP) remains a major cause of morbidity and mortality among human immunodeficiency virus (HIV)-infected patients and incurs high health costs. Areas covered: This article reviews the most recent publications on bacterial CAP in the HIV-infected population, focusing on epidemiology, prognostic factors, microbial etiology, therapy, and prevention. The data discussed here were mainly obtained from a non-systematic review using Medline, and references from relevant articles. Expert commentary: HIV-infected patients are more susceptible to bacterial CAP. Although ART improves their immune response and has reduced CAP incidence, these patients continue to present increased risk of pneumonia in part because they show altered immunity and because immune activation persists. The risk of CAP in HIV-infected patients and the probability of polymicrobial or atypical infections are inversely associated with the CD4 cell count. Mortality in HIV-infected patients with CAP ranges from 6% to 15% but in well-controlled HIV-infected patients on ART the mortality is low and similar to that seen in HIV-negative individuals. Vaccination and smoking cessation are the two most important preventive strategies for bacterial CAP in well-controlled HIV-infected patients on ART.
尽管进行了积极的抗逆转录病毒治疗（ART），但社区获得性肺炎（CAP）仍然是导致人类免疫缺陷病毒（HIV）感染患者发病率和死亡率的主要原因，并带来了高昂的健康成本。
本文综述了 HIV 感染人群中细菌性 CAP 的最新文献，重点关注流行病学、预后因素、微生物病因、治疗和预防。本文讨论的数据主要是通过使用 Medline 进行的非系统性综述以及相关文章的参考文献获得的。
HIV 感染患者更容易发生细菌性 CAP。尽管 ART 改善了他们的免疫反应，降低了 CAP 的发病率，但这些患者仍持续存在肺炎风险增加的问题，部分原因是他们的免疫发生了改变，而且免疫激活仍然存在。HIV 感染患者 CAP 的风险以及多微生物或非典型感染的可能性与 CD4 细胞计数呈反比。HIV 感染 CAP 患者的死亡率为 6%至 15%，但在接受 ART 治疗且 HIV 得到良好控制的 HIV 感染患者中，死亡率较低，与 HIV 阴性个体相似。在接受 ART 治疗且 HIV 得到良好控制的患者中，疫苗接种和戒烟是预防细菌性 CAP 的两个最重要的策略。
