Epling Brian P, Manion Maura, Sirajuddin Arlene, Laidlaw Elizabeth, Galindo Frances, Anderson Megan, Roby Gregg, Rocco Joseph M, Lisco Andrea, Sheikh Virginia, Kovacs Joseph A, Sereti Irini
National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA.
Radiology & Imaging Sciences Department, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA.
Open Forum Infect Dis. 2023 Jul 31;10(8):ofad408. doi: 10.1093/ofid/ofad408. eCollection 2023 Aug.
pneumonia (PCP) is one of the most frequent opportunistic infections in people with HIV (PWH). However, there are limited data on long-term outcomes of PCP in the antiretroviral therapy (ART) era.
We conducted a secondary analysis of 2 prospective studies on 307 PWH, 81 with prior PCP, with a median follow-up of 96 weeks. Laboratory data were measured at protocol-defined intervals. We reviewed clinically indicated chest computerized tomography imaging in 63 patients with prior PCP at a median of 58 weeks after PCP diagnosis and pulmonary function tests (PFTs) of patients with (n = 10) and without (n = 14) prior PCP at a median of 18 weeks after ART initiation.
After 96 weeks of ART, PWH with prior PCP showed no significant differences in laboratory measurements, including CD4 count, when compared with those without prior PCP. Survival rates following ART initiation were similar. However, PWH with prior PCP had increased evidence of restrictive lung pathology and diffusion impairment in PFTs. Furthermore, on chest imaging, 13% of patients had bronchiectasis and 11% had subpleural cysts. Treatment with corticosteroids was associated with an increased incidence of cytomegalovirus disease (odds ratio, 2.62; = .014).
PCP remains an important opportunistic infection in the ART era. While it did not negatively affect CD4 reconstitution, it could pose an increased risk for incident cytomegalovirus disease with corticosteroid treatment and may cause residual pulmonary sequelae. These findings suggest that PCP and its treatment may contribute to long-term morbidity in PWH, even in the ART era.
肺炎（肺孢子菌肺炎，PCP）是人类免疫缺陷病毒（HIV）感染者（PWH）中最常见的机会性感染之一。然而，在抗逆转录病毒治疗（ART）时代，关于PCP长期预后的数据有限。
我们对两项前瞻性研究进行了二次分析，研究对象为307例PWH，其中81例曾患PCP，中位随访时间为96周。实验室数据按方案规定的时间间隔进行测量。我们回顾了63例曾患PCP患者在PCP诊断后中位58周时的临床指示胸部计算机断层扫描成像，以及10例曾患PCP和14例未患PCP患者在ART开始后中位18周时的肺功能测试（PFT）。
ART治疗96周后，曾患PCP的PWH与未患PCP的PWH相比，在包括CD4细胞计数在内的实验室测量指标上无显著差异。开始ART后的生存率相似。然而，曾患PCP的PWH在PFT中出现限制性肺病理和弥散功能障碍的证据增加。此外，在胸部影像学检查中，13%的患者有支气管扩张，11%的患者有胸膜下囊肿。使用糖皮质激素治疗与巨细胞病毒疾病发病率增加相关（比值比，2.62；P = 0.014）。
在ART时代，PCP仍然是一种重要的机会性感染。虽然它对CD4细胞重建没有负面影响，但使用糖皮质激素治疗可能会增加巨细胞病毒疾病的发病风险，并可能导致残留的肺部后遗症。这些发现表明，即使在ART时代，PCP及其治疗也可能导致PWH的长期发病。
