Wallace J M, Hansen N I, Lavange L, Glassroth J, Browdy B L, Rosen M J, Kvale P A, Mangura B T, Reichman L B, Hopewell P C
Department of Medicine, Olive View-UCLA Medical Center, Sylmar, California 91342, USA.
Am J Respir Crit Care Med. 1997 Jan;155(1):72-80. doi: 10.1164/ajrccm.155.1.9001292.
We examined trends in the incidence of specific respiratory disorders in a multicenter cohort with progressive human immunodeficiency virus (HIV) disease during a 5-yr period. Individuals with a wide range of HIV disease severity belonging to three transmission categories were evaluated at regular intervals and for episodic respiratory symptoms using standard diagnostic algorithms. Yearly incidence rates of respiratory diagnoses were assessed in the cohort as a whole and according to CD4 count or HIV transmission category. The most frequent respiratory disorders were upper respiratory tract infections, but the incidence of lower respiratory tract infections increased as CD4 counts declined. Specific lower respiratory infections followed distinctive patterns according to study-entry CD4 count and transmission category. Acute bronchitis was the predominant lower respiratory infection of cohort members with entry CD4 counts > or = 200 cells/mm3. In cohort members with entry CD4 counts of 200 to 499 cells/mm3, the incidence of bacterial and Pneumocystis carinii pneumonia each increased an average of 40% per year. In members with entry CD4 counts < 200 cells/mm3, acute bronchitis, bacterial pneumonia, and P. carinii pneumonia occurred at high rates without discernible time trends, despite chemoprophylaxis in more than 80% after Year 1, and the rate of other pulmonary opportunistic infections increased over time. Each year, injecting drug users had a higher incidence of bacterial pneumonia than did homosexual men. The yearly rate of tuberculosis was < 3 episodes/100 person-yr in each entry CD4 and HIV-transmission group. We conclude that the time trends of HIV-associated respiratory disorders are determined by HIV disease stage and influenced by transmission category. Whereas acute bronchitis is prevalent during all stages of HIV infection, incidence rates of bacterial pneumonia and P. carinii pneumonia rise continuously during progression to advanced disease. In advanced disease, the incidence of acute bronchitis, bacterial pneumonia and P. carinii pneumonia is high despite widespread chemoprophylaxis.
我们在一个多中心队列中研究了5年期间患有进展性人类免疫缺陷病毒（HIV）疾病的患者特定呼吸道疾病的发病率趋势。对属于三种传播类别、HIV疾病严重程度范围广泛的个体进行定期评估，并使用标准诊断算法评估发作性呼吸道症状。在整个队列中以及根据CD4细胞计数或HIV传播类别评估呼吸道诊断的年发病率。最常见的呼吸道疾病是上呼吸道感染，但随着CD4细胞计数下降，下呼吸道感染的发病率增加。根据研究入组时的CD4细胞计数和传播类别，特定的下呼吸道感染呈现出不同的模式。急性支气管炎是入组时CD4细胞计数≥200个细胞/mm³的队列成员中主要的下呼吸道感染。在入组时CD4细胞计数为200至499个细胞/mm³的队列成员中，细菌性肺炎和卡氏肺孢子虫肺炎的发病率每年平均增加40%。在入组时CD4细胞计数＜200个细胞/mm³的成员中，急性支气管炎、细菌性肺炎和卡氏肺孢子虫肺炎的发生率很高，且无明显的时间趋势，尽管在第1年后超过80%的患者接受了化学预防，其他肺部机会性感染的发生率随时间增加。每年，注射吸毒者细菌性肺炎的发病率高于同性恋男性。在每个入组CD4细胞计数和HIV传播组中，结核病的年发病率＜3例/100人年。我们得出结论，HIV相关呼吸道疾病的时间趋势由HIV疾病阶段决定，并受传播类别的影响。虽然急性支气管炎在HIV感染的所有阶段都很普遍，但在进展为晚期疾病的过程中，细菌性肺炎和卡氏肺孢子虫肺炎的发病率持续上升。在晚期疾病中，尽管广泛进行了化学预防，急性支气管炎、细菌性肺炎和卡氏肺孢子虫肺炎的发病率仍然很高。
