我们是否应该关注间日疟原虫和 HIV 合并感染？来自巴西亚马逊地区的系统评价和病例系列。

Should we care about Plasmodium vivax and HIV co-infection? A systematic review and a cases series from the Brazilian Amazon.

机构信息

Programa de Pós-Graduação Em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil.

Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.

出版信息

Malar J. 2021 Jan 6;20(1):13. doi: 10.1186/s12936-020-03518-9.

DOI:10.1186/s12936-020-03518-9

PMID:33407474

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7788992/

Abstract

BACKGROUND

Malaria and HIV are two important public health issues. However, evidence on HIV-Plasmodium vivax co-infection (HIV/PvCo) is scarce, with most of the available information related to Plasmodium falciparum on the African continent. It is unclear whether HIV can change the clinical course of vivax malaria and increase the risk of complications. In this study, a systematic review of HIV/PvCo studies was performed, and recent cases from the Brazilian Amazon were included.

METHODS

Medical records from a tertiary care centre in the Western Brazilian Amazon (2009-2018) were reviewed to identify HIV/PvCo hospitalized patients. Demographic, clinical and laboratory characteristics and outcomes are reported. Also, a systematic review of published studies on HIV/PvCo was conducted. Metadata, number of HIV/PvCo cases, demographic, clinical, and outcome data were extracted.

RESULTS

A total of 1,048 vivax malaria patients were hospitalized in the 10-year period; 21 (2.0%) were HIV/PvCo cases, of which 9 (42.9%) had AIDS-defining illnesses. This was the first malaria episode in 11 (52.4%) patients. Seven (33.3%) patients were unaware of their HIV status and were diagnosed on hospitalization. Severe malaria was diagnosed in 5 (23.8%) patients. One patient died. The systematic review search provided 17 articles (12 cross-sectional or longitudinal studies and 5 case report studies). A higher prevalence of studies involved cases in African and Asian countries (35.3 and 29.4%, respectively), and the prevalence of reported co-infections ranged from 0.1 to 60%.

CONCLUSION

Reports of HIV/PvCo are scarce in the literature, with only a few studies describing clinical and laboratory outcomes. Systematic screening for both co-infections is not routinely performed, and therefore the real prevalence of HIV/PvCo is unknown. This study showed a low prevalence of HIV/PvCo despite the high prevalence of malaria and HIV locally. Even though relatively small, this is the largest case series to describe HIV/PvCo.

摘要

背景

疟疾和艾滋病是两个重要的公共卫生问题。然而，有关艾滋病合并疟原虫 vivax 感染（HIV/PvCo）的证据很少，现有的大部分信息都与非洲大陆的疟原虫 falciparum 有关。目前尚不清楚 HIV 是否会改变 vivax 疟疾的临床过程并增加并发症的风险。本研究对 HIV/PvCo 研究进行了系统评价，并纳入了巴西亚马逊地区的最新病例。

方法

对巴西西部亚马逊地区一家三级保健中心（2009-2018 年）的医疗记录进行了回顾性分析，以确定 HIV/PvCo 住院患者。报告了人口统计学、临床和实验室特征以及结局。此外，还对已发表的 HIV/PvCo 研究进行了系统评价。提取元数据、HIV/PvCo 病例数、人口统计学、临床和结局数据。

结果

在 10 年期间，共有 1048 例 vivax 疟疾患者住院，其中 21 例（2.0%）为 HIV/PvCo 病例，其中 9 例（42.9%）患有艾滋病定义性疾病。这是 11 例（52.4%）患者的首次疟疾发作。7 例（33.3%）患者不知道自己的 HIV 状况，是在住院期间诊断出来的。5 例（23.8%）患者被诊断为严重疟疾。1 例患者死亡。系统评价搜索提供了 17 篇文章（12 篇横断面或纵向研究和 5 篇病例报告研究）。涉及病例的研究中，来自非洲和亚洲国家的报告比例较高（分别为 35.3%和 29.4%），报告的合并感染率从 0.1%到 60%不等。

结论

文献中关于 HIV/PvCo 的报道很少，只有少数研究描述了临床和实验室结局。对这两种合并感染的系统筛查并未常规进行，因此 HIV/PvCo 的真实流行率尚不清楚。尽管疟疾和 HIV 在当地的流行率较高，但本研究显示 HIV/PvCo 的流行率较低。尽管相对较小，但这是描述 HIV/PvCo 的最大病例系列。