Lifson A R, Olson R, Roberts S G, Poscher M E, Drew W L, Conant M A
Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco.
J Am Board Fam Pract. 1994 Jul-Aug;7(4):288-91.
Clinicians caring for patients who have acquired immunodeficiency syndrome (AIDS) need to be aware of the wide variety of infectious diseases that can occur. Although Pneumocystis carinii pneumonia (PCP) is the most common AIDS-defining infection, other opportunistic infections associated with advanced immunodeficiency can develop after an initial diagnosis.
To ascertain AIDS-defining opportunistic infections that developed at the time of or after an AIDS diagnosis, and intensive chart review was conducted for 45 homosexual men with AIDS who died from 1990 through 1992. Time to death after first occurrence of these infections was also determined.
The most common opportunistic infection occurring as the initial AIDS-defining illness was PCP (31 percent). The most common opportunistic infection occurring as a secondary disease was cytomegalovirus (CMV) disease (40 percent), followed by disseminated Mycobacterium avium complex (33 percent) and invasive candidiasis (31 percent). Each of these latter infections was associated with a poor prognosis (median time to death < or = 8 months).
Diseases caused by CMV, disseminated M. avium complex, and invasive candidiasis were uncommon presenting manifestations of AIDS but were common secondary diseases that tended to be associated with limited survival. With increasing survival and a declining incidence of PCP as a result of medical therapy, other severe opportunistic infections might become increasingly recognized.
治疗获得性免疫缺陷综合征（AIDS）患者的临床医生需要了解可能出现的各种各样的传染病。虽然卡氏肺孢子虫肺炎（PCP）是最常见的艾滋病界定性感染，但在初次诊断后，与晚期免疫缺陷相关的其他机会性感染也可能发生。
为确定在艾滋病诊断时或之后发生的艾滋病界定性机会性感染，对1990年至1992年间死亡的45名患有艾滋病的同性恋男性进行了详细的病历审查。还确定了这些感染首次出现后至死亡的时间。
作为最初的艾滋病界定性疾病出现的最常见机会性感染是PCP（31%）。作为继发疾病出现的最常见机会性感染是巨细胞病毒（CMV）病（40%），其次是播散性鸟分枝杆菌复合体（33%）和侵袭性念珠菌病（31%）。这些后期感染中的每一种都与预后不良相关（中位死亡时间≤8个月）。
由CMV、播散性鸟分枝杆菌复合体和侵袭性念珠菌病引起的疾病是艾滋病不常见的首发表现，但却是常见的继发疾病，往往与生存期有限相关。随着生存期的延长以及由于药物治疗PCP发病率的下降，其他严重的机会性感染可能会越来越多地被认识到。
