Department for Adult's Infectious Diseases, Hospital for Infectious Diseases, Medical University of Warsaw, Warsaw, Poland.
Hospital for Infectious Diseases, HIV Out-Patient Clinic, Warsaw, Poland.
PLoS One. 2022 Jul 7;17(7):e0270770. doi: 10.1371/journal.pone.0270770. eCollection 2022.
The risk and characteristics of upper respiratory tract (URT) bacterial infections (URT-BI) among HIV (+) patients is understudied. We analyzed factors associated with its occurrence and the spectrum of culturable pathogens among patients routinely followed at the HIV Out-Patient Clinic in Warsaw.
All HIV (+) patients with available URT swab culture were included into analyses. Patients were followed from the day of registration in the clinic until first positive URT swab culture or last clinical visit from January 1, 2007 to July 31, 2016. Cox proportional hazard models were used to identify factors associated with positive URT swabs culture (those with p<0.1 in univariate included into multivariable).
In total 474 patients were included into the analyses, 166 with culturable URT swab. In general, 416 (87.8%) patients were male, 342 (72.1%) were infected through MSM contact, 253 (53.4%) were on antiretroviral therapy. Median follow-up time was 3.4 (1.3-5.7) years, age 35.2 (30.6-42.6) years and CD4+ count 528 (400-685) cells/μl. The most common cultured bacteria were S. aureus (40.4%) and S. pyogenes (13.9%) (Table 1). Patients with culturable URT-BI were more likely to be MSM (68.5% vs 78.9%; p<0.016), have detectable viral load (20.9% vs 12.0%; p<0.0001) and CD4+ cell count <500 cells/μl (55.2% vs 39.0%; p = 0.003) (Table 2). In multivariate survival analyses detectable viral load (HR3.13; 95%Cl: 2.34-4.19) and MSM (1.63;1.09-2.42) were increasing, but older age (0.63;0.58-0.69, per 5 years older) and higher CD4+ count (0.90;0.85-0.95, per 100 cells/μl) decreasing the risk of culturable URT-BI (Table 2).
Culturable URT-BI are common among HIV-positive patients with high CD4+ count. Similarly to general population most common cultured bacteria were S. aureus and S. pyogenes. Risk factors identified in multivariate survival analysis indicate that younger MSM patients with detectable HIV viral load are at highest risk. In clinical practice this group of patients requires special attention.
HIV(+)患者上呼吸道（URT）细菌感染（URT-BI）的风险和特征尚未得到充分研究。我们分析了与URT 拭子培养阳性相关的因素，并确定了在华沙 HIV 门诊常规就诊患者中可培养病原体的范围。
所有可进行 URT 拭子培养的 HIV(+)患者均纳入分析。患者从登记之日起在诊所接受随访，直至首次 URT 拭子培养阳性或 2007 年 1 月 1 日至 2016 年 7 月 31 日最后一次临床就诊。使用 Cox 比例风险模型确定与 URT 拭子培养阳性相关的因素（单因素分析中 p<0.1 的因素纳入多因素分析）。
共纳入 474 例患者进行分析，其中 166 例培养出 URT 拭子可培养的病原体。一般来说，416 例（87.8%）患者为男性，342 例（72.1%）通过男男性接触感染，253 例（53.4%）正在接受抗逆转录病毒治疗。中位随访时间为 3.4（1.3-5.7）年，年龄为 35.2（30.6-42.6）岁，CD4+计数为 528（400-685）个/μl。最常见的培养细菌为金黄色葡萄球菌（40.4%）和化脓性链球菌（13.9%）（表 1）。可培养 URT-BI 的患者更有可能是男男性接触者（68.5% vs 78.9%；p<0.016）、病毒载量可检测（20.9% vs 12.0%；p<0.0001）和 CD4+细胞计数<500 个/μl（55.2% vs 39.0%；p=0.003）（表 2）。在多变量生存分析中，可检测到的病毒载量（HR3.13；95%CI：2.34-4.19）和男男性接触（1.63；1.09-2.42）呈上升趋势，而年龄较大（0.63；0.58-0.69，每增加 5 岁）和 CD4+计数较高（0.90；0.85-0.95，每增加 100 个/μl）降低了可培养 URT-BI 的风险（表 2）。
高 CD4+计数的 HIV 阳性患者中可培养 URT-BI 很常见。与一般人群一样，最常见的培养细菌是金黄色葡萄球菌和化脓性链球菌。多变量生存分析中确定的危险因素表明，具有可检测 HIV 病毒载量的年轻男男性接触者风险最高。在临床实践中，这群患者需要特别关注。
