Soriano V, Valencia E, Alba A, Laguna F, Moreno V, Alberdi J C, García-Samaniego J, González-Lahoz J
Servicio de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid.
Med Clin (Barc). 1993 Dec 4;101(19):736-40.
Infections in subjects with HIV-1 infection are a frequent cause of hospital admission. Knowledge of the entities which most often motivate hospitalization may aid in designing the most appropriate diagnostic and prophylactic strategies. The causes of hospital admission in individuals with risk practices for HIV-1 infection attended in a Department of Infectious Diseases in Madrid over a period of 4 years were analyzed.
The records of the patients admitted from 1989 to 1992 were retrospectively reviewed. The principal and associated diagnoses which led to hospitalization were considered. The admissions of the two years were compared.
Bacterial pneumonias were the principal cause of hospitalization in the 2 years studied. Forty-five percent of the infections leading to hospital admission were not included among those defining AIDS. Tuberculosis was the most frequent opportunistic infection. Admissions due to pulmonary pneumocystosis, tuberculosis, toxoplasmosis, esophageal candidiasis and Kaposi's sarcoma decreased from 1989-1992. To the contrary, disseminated Mycobacterium avium complex infection and systemic infection by cytomegalovirus significantly increased over the same period. The incidence of other diseases such as endocarditis or leishmaniasis remained stable. More than half of the diseases were diagnosed in association with another entity during the same admission. Likewise, an increase in atypical forms of infections thus making diagnosis and treatment more difficult was observed. The first cases of multiresistant tuberculosis, all of rapidly fatal evolution, were identified in 1992. Mean hospital stay increased 30% and the rate of mortality was of 9% in 1989 and rose to 20% in 1992.
The spectrum of infections which led to hospital admission of patients with HIV-1 infection has significantly modified over the last 4 years being related with the generalization of prophylactic medication for some opportunistic infections, the improvement of certain diagnostic techniques and more frequent ambulatory treatment of some diseases. The mean length of stay and hospital mortality have increased in the HIV+ population.
HIV - 1感染患者的感染是住院的常见原因。了解最常导致住院的病因有助于设计最合适的诊断和预防策略。分析了马德里一家传染病科在4年期间收治的有HIV - 1感染风险行为个体的住院原因。
回顾性分析1989年至1992年入院患者的病历。考虑导致住院的主要和相关诊断。比较了这两年的入院情况。
在所研究的两年中，细菌性肺炎是住院的主要原因。导致住院的感染中有45%未被列入艾滋病定义的感染中。结核病是最常见的机会性感染。1989 - 1992年，因肺孢子菌肺炎、结核病、弓形虫病、食管念珠菌病和卡波西肉瘤导致的入院人数减少。相反，同期播散性鸟分枝杆菌复合群感染和巨细胞病毒全身感染显著增加。心内膜炎或利什曼病等其他疾病的发病率保持稳定。超过一半的疾病在同一次住院期间与另一种疾病相关诊断。同样，观察到非典型感染形式增加，从而使诊断和治疗更加困难。1992年发现了首例多重耐药结核病，所有病例病情进展迅速且致命。平均住院时间在1989年增加了30%，死亡率为9%，1992年升至20%。
在过去4年中，导致HIV - 1感染患者住院的感染谱发生了显著变化，这与某些机会性感染预防性用药的普及、某些诊断技术的改进以及一些疾病更频繁的门诊治疗有关。HIV阳性人群的平均住院时间和医院死亡率有所增加。
