Sorvillo F, Beall G, Turner P A, Beer V L, Kovacs A A, Kerndt P R
HIV Epidemiology Program, Los Angeles County Department of Health Services, CA 90005, USA.
AIDS. 1997 Apr;11(5):673-9. doi: 10.1097/00002030-199705000-00016.
To determine the incidence and factors associated with extrapulmonary cryptococcosis among a cohort of persons with HIV in Los Angeles County.
Records-based cohort study.
Data were analysed from a cohort of 3836 persons aged > or = 13 years with HIV infection enrolled from four outpatient facilities in Los Angeles from 1990 to 1995. The potential association between cryptococcosis and demographic risk behavior and clinical factors was assessed. Possible seasonal clustering was evaluated and an estimate of survival following cryptococcosis was calculated. Multivariate analysis was performed using a Cox proportional hazards approach.
Cryptococcosis was identified in 112 patients (2.9%) representing a crude incidence rate of 1.7 cases per 100 person-years experience. The rate of cryptococcosis was higher among men than women (1.9 and 0.6, respectively; P < 0.01) and in Hispanics than in whites (2.3 and 1.2, respectively, P < 0.01). A significant trend of decreasing cryptococcosis was observed with increasing age (P < 0.01). Cryptococcosis increased with declining CD4+ lymphocyte count, with risk being greatest at CD4+ cell counts below 100 x 10(6)/l (P < 0.001). In bivariate analysis persons with a history of antifungal medication had a marginally lower rate of cryptococcosis, but this difference was not statistically significant. The rate of cryptococcosis was significantly higher in fall and winter months [rate ratio (RR), 1.45; 95% confidence interval (CI), 1.0-2.3; P = 0.05]. After controlling for other variables, cryptococcosis was more common in men than women (adjusted RR, 3.2; 95% CI, 1.0-10.4) and in Hispanics than whites (adjusted RR, 1.6; 95% CI, 0.9-2.7). Both CD4+ count and age continued to be strongly associated with the occurrence of cryptococcosis. After controlling for other factors a substantial protective effect was observed for antifungal therapy (adjusted RR, 0.48; 95% CI, 0.29-0.79).
Our data suggest that HIV-infected men, Hispanics, persons aged under 45 years and those with CD4+ counts under 100 x 10(6)/l have an increased risk of extrapulmonary cryptococcosis. A fall-winter seasonality in the occurrence of cryptococcosis may exist. Significant primary protection against cryptococcal disease is afforded by antifungal therapy. These results may provide insight into possible routes of transmission and sources of cryptococcal infection and help guide both primary prophylaxis and early recognition and diagnosis in persons likely to be at increased risk.
确定洛杉矶县感染人类免疫缺陷病毒（HIV）人群中肺外隐球菌病的发病率及相关因素。
基于记录的队列研究。
对1990年至1995年期间从洛杉矶4个门诊机构招募的3836名年龄≥13岁的HIV感染者队列数据进行分析。评估隐球菌病与人口统计学风险行为及临床因素之间的潜在关联。评估可能的季节性聚集情况，并计算隐球菌病后的生存率估计值。采用Cox比例风险法进行多变量分析。
112例患者（2.9%）被诊断为隐球菌病，粗发病率为每100人年1.7例。男性隐球菌病发病率高于女性（分别为1.9和0.6；P<0.01），西班牙裔高于白人（分别为2.3和1.2，P<0.01）。随着年龄增长，隐球菌病呈显著下降趋势（P<0.01）。隐球菌病随CD4+淋巴细胞计数下降而增加，CD4+细胞计数低于100×10⁶/l时风险最大（P<0.001）。在双变量分析中，有抗真菌药物治疗史的人隐球菌病发病率略低，但差异无统计学意义。秋冬季节隐球菌病发病率显著更高[率比（RR），1.45；95%置信区间（CI），1.0 - 2.3；P = 0.05]。在控制其他变量后，男性隐球菌病比女性更常见（调整RR，3.2；95%CI，1.0 - 10.4），西班牙裔比白人更常见（调整RR，1.6；95%CI，0.9 - 2.7）。CD4+计数和年龄仍与隐球菌病的发生密切相关。在控制其他因素后，观察到抗真菌治疗有显著的保护作用（调整RR，0.48；95%CI，0.29 - 0.79）。
我们的数据表明，HIV感染男性、西班牙裔、45岁以下人群以及CD4+计数低于1×10⁵/μl的人群肺外隐球菌病风险增加。隐球菌病的发生可能存在秋冬季节性。抗真菌治疗对隐球菌病有显著的一级预防作用。这些结果可能有助于深入了解隐球菌感染的可能传播途径和来源，并有助于指导对可能风险增加人群的一级预防以及早期识别和诊断。
