Moorman A C, Von Bargen J C, Palella F J, Holmberg S D
Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
J Acquir Immune Defic Syndr Hum Retrovirol. 1998 Oct 1;19(2):182-8. doi: 10.1097/00042560-199810010-00013.
Pneumocystis carinii pneumonia (PCP) remains the most frequently reported serious opportunistic infection in AIDS patients and the second highest cause of mortality among persons with AIDS in the United States, despite the availability of effective chemoprophylaxis.
To evaluate incidence of PCP and determinants of PCP chemoprophylaxis failure, we analyzed data from 2842 patients visits to infectious diseases physicians at 10 HIV clinics (eight private and two public) in eight U.S. cities from January 1992 through June 1996 as part of the HIV Outpatient Study (HOPS). We performed a time-dependent regression analysis to examine potential determinants of PCP chemoprophylaxis failure.
The incidence of chemoprophylaxis failure was 4.6 PCP cases/100 person-years on chemoprophylaxis; these cases represent 67% of all incident episodes of PCP. In a multivariate analysis, the only significant predictors of chemoprophylaxis failure were the use of agents other than trimethoprim-sulfamethoxazole (TMP-SMX), history of prior PCP, and a CD4+ T-lymphocyte cell count of <50 cells/microl. Dosing or frequency of TMP-SMX did not seem to influence risk of chemoprophylaxis failure.
Chemoprophylaxis failure, especially among those with the most advanced immunosuppression or history of prior PCP, was the most significant source of new PCP cases in the HOPS cohort and thus represents one of the largest contributors to morbidity and mortality in this cohort.
尽管有有效的化学预防措施，但卡氏肺孢子虫肺炎（PCP）仍是美国艾滋病患者中最常报告的严重机会性感染，也是艾滋病患者中第二大死亡原因。
为评估PCP的发病率及PCP化学预防失败的决定因素，我们分析了1992年1月至1996年6月期间，作为艾滋病门诊研究（HOPS）一部分的，来自美国8个城市10家艾滋病诊所（8家私立和2家公立）的2842例患者就诊于传染病医生的数据。我们进行了时间依赖性回归分析，以检查PCP化学预防失败的潜在决定因素。
化学预防失败的发生率为4.6例PCP/100人年化学预防；这些病例占所有PCP发病病例的67%。在多变量分析中，化学预防失败的唯一显著预测因素是使用甲氧苄啶-磺胺甲恶唑（TMP-SMX）以外的药物、既往PCP病史以及CD4+T淋巴细胞计数<50个细胞/微升。TMP-SMX的给药剂量或频率似乎不影响化学预防失败的风险。
化学预防失败，尤其是在免疫抑制最严重或有既往PCP病史的患者中，是HOPS队列中新发PCP病例的最重要来源，因此是该队列中发病和死亡的最大贡献因素之一。
