Payen M C, De Wit S, Clumeck N
CHU Saint-Pierre, Bruxelles, Belgique.
Rev Mal Respir. 1997 Dec;14 Suppl 5:S142-51.
The most frequent bacterial infections in patients infected with HIV and suffering from AIDS are non-tuberculous mycobacterial infections. Their incidence is increasing all the more as the survival of profoundly immunocompromised patients is prolonged. There are unknown factors as regards the precise origin of these infections and as to the exact epidemiology of atypical mycobacteria. It is known that 95 per cent of atypical mycobacterial infections are due to M. avium. If the pathophysiology of the infection (involving the intervention of cytokines and also factors in relation to the virulence of the germ) is imperfectly understood, the atypical mycobacteria are an independent cause of mortality in advanced stages of the disease. The clinical picture is that of a low grade fever with weight loss and a deterioration in the general physical state. There are subtle physical signs such as a fall in the functional capacity accompanied by weight loss and an unexplained anaemia these should also suggest a diagnosis. More rarely the infection will be localised. The clinical diagnosis will be confirmed by bacteriology which has been aided by recent progress in molecular biology. With the arrival of the newer macrolides it has been shown that treatment prolongs survival in a significant manner. Current recommendations consist of a treatment with a combined regime including a minimum of Clarithyromycin and Ethambutol. The place for polychemotherapy remains to be determined in particular the role for Rifabutine and Amikacine. Immunomodulation by interferon-gamma or GCSF are also under review. The duration of treatment and the necessity of long term suppressive treatment is the object of randomised studies. Prophylaxis is currently recommended for patients with CD4 < 75/mm3. The role of Rifabutine and the new macrolides remains to be determined. Finally, in a large European study the objective is to compare prophylaxis to systematic bacteriological surveillance both as regards efficacy, tolerance, and in terms of pharmaco-economics.
感染人类免疫缺陷病毒（HIV）并患有获得性免疫缺陷综合征（AIDS）的患者中，最常见的细菌感染是非结核分枝杆菌感染。随着严重免疫功能低下患者生存期的延长，其发病率越来越高。关于这些感染的确切起源以及非典型分枝杆菌的确切流行病学，存在一些未知因素。已知95%的非典型分枝杆菌感染是由鸟分枝杆菌引起的。虽然对感染的病理生理学（涉及细胞因子的干预以及与病菌毒力相关的因素）了解尚不完善，但非典型分枝杆菌是该疾病晚期的一个独立死亡原因。临床表现为低热、体重减轻和全身状况恶化。有一些细微的体征，如功能能力下降伴体重减轻和不明原因的贫血，这些也应提示诊断。感染较少局限于局部。临床诊断将通过细菌学得到证实，分子生物学的最新进展对此有帮助。随着新型大环内酯类药物的出现，已表明治疗能显著延长生存期。目前的建议是采用联合治疗方案，至少包括克拉霉素和乙胺丁醇。多药化疗的作用，特别是利福布汀和阿米卡星的作用，仍有待确定。干扰素-γ或粒细胞集落刺激因子（GCSF）的免疫调节作用也在研究中。治疗持续时间和长期抑制治疗的必要性是随机研究的对象。目前建议对CD4<75/mm³的患者进行预防。利福布汀和新型大环内酯类药物的作用仍有待确定。最后，在一项大型欧洲研究中，目标是比较预防和系统性细菌学监测在疗效、耐受性和药物经济学方面的差异。
