Ampel N M, Dols C L, Galgiani J N
Medical Service, Tucson Veterans Affairs Medical Center, Arizona 86723.
Am J Med. 1993 Mar;94(3):235-40. doi: 10.1016/0002-9343(93)90054-s.
To determine the incidence of active coccidioidomycosis among subjects infected with the human immunodeficiency virus (HIV) living in an area endemic for coccidioidomycosis and to identify factors associated with the development of active coccidioidomycosis in these patients.
This was a prospective cohort analysis of HIV-infected subjects living in an area endemic for coccidioidomycosis in Arizona. On entry and at approximately 4-month intervals, subjects were interviewed and examined, and had spherulin skin testing and CD4 lymphocyte counts performed along with other tests. During each interval, it was determined whether the subject had developed active coccidioidomycosis according to established criteria.
One hundred seventy subjects entered the study. Median follow-up was 11.3 months (range: 0 to 44 months). Thirteen subjects developed active coccidioidomycosis, with an estimated cumulative incidence of 24.6% by 41 months (95% confidence limits 8.2% and 41.1%). Risk factors associated with the development of active coccidioidomycosis in the cohort were a CD4 lymphocyte count of less than 0.250 x 10(9)/L and a diagnosis of acquired immunodeficiency syndrome. Factors associated with prior coccidioidal infection, including a positive spherulin skin test, length of residence in the endemic area for more than 25 months, and a prior history of coccidioidomycosis, were not associated with the development of active infection.
Active coccidioidomycosis among individuals infected with HIV is common in the coccidioidal endemic area. Immunodeficiency appears to be the major risk factor for the development of disease. Evidence of prior coccidioidomycosis, including a positive spherulin skin test, does not appear to predict the development of active infection.
确定生活在球孢子菌病流行地区的感染人类免疫缺陷病毒（HIV）的受试者中活动性球孢子菌病的发病率，并确定这些患者中与活动性球孢子菌病发生相关的因素。
这是一项对生活在亚利桑那州球孢子菌病流行地区的HIV感染受试者进行的前瞻性队列分析。在入组时及大约每4个月的间隔时间，对受试者进行访谈和检查，并进行球孢子菌素皮肤试验以及CD4淋巴细胞计数和其他检查。在每个间隔期，根据既定标准确定受试者是否发生了活动性球孢子菌病。
170名受试者进入研究。中位随访时间为11.3个月（范围：0至44个月）。13名受试者发生了活动性球孢子菌病，到41个月时估计累积发病率为24.6%（95%置信区间为8.2%和41.1%）。该队列中与活动性球孢子菌病发生相关的危险因素是CD4淋巴细胞计数低于0.250×10⁹/L以及获得性免疫缺陷综合征的诊断。与既往球孢子菌感染相关的因素，包括球孢子菌素皮肤试验阳性、在流行地区居住超过25个月以及既往有球孢子菌病病史，均与活动性感染的发生无关。
在球孢子菌病流行地区，HIV感染个体中活动性球孢子菌病很常见。免疫缺陷似乎是疾病发生的主要危险因素。既往球孢子菌病的证据，包括球孢子菌素皮肤试验阳性，似乎并不能预测活动性感染的发生。
