Michelet C, Arvieux C, François C, Besnier J M, Rogez J P, Breux J P, Souala F, Allavena C, Raffi F, Garre M, Cartier F
Infectious Disease Unit, Hopital Pontchaillou, University hospital, Rennes, France.
AIDS. 1998 Oct 1;12(14):1815-22. doi: 10.1097/00002030-199814000-00013.
To analyse the characteristics of opportunistic infections in patients receiving highly active antiretroviral treatment (HAART).
A retrospective study performed in seven hospitals, included all patients starting treatment by ritonavir or indinavir between 26 March and 31 December 1996. Patients were evaluated for the development of AIDS-defining events. Clinical evaluation, plasma HIV-1 RNA quantification, CD4 cell count were recorded at baseline and at the onset of the event.
Four hundred and eighty-six patients were included: 44.2% had a CD4 cell count below 50 x 10(6) cells/l. Fifty clinical events were recorded in 46 patients with a mean follow-up of 6.1 months, of which 34 events (68%) were observed during the first 2 months of HAART. Eighteen of these occurred despite a reduction of viral load by at least 1.5 log10) and a 100% increase of the CD4 cell count compared with that at the onset of the event, corresponding to 11 cytomegalovirus infections, five mycobacterial infections, one case of cryptococcosis, and one case of Varicella-Zoster virus-related acute retinal necrosis. Among the 16 events observed after the second month, six occurred despite a marked biological improvement, corresponding to a recurrence in five of six patients who had stopped their maintenance therapy. Events were one cytomegalovirus infection, two mycobacterial infections, one episode of oesophageal candidiasis and one cryptococcal meningitis.
In patients at high risk of developing an opportunistic infection prior to the institution of a HAART regimen, prophylaxis should not be discontinued during the first 2 months of treatment, and maintenance therapy should be carried on despite a significant increase in the CD4 cell count.
分析接受高效抗逆转录病毒治疗（HAART）患者的机会性感染特征。
在七家医院进行的一项回顾性研究，纳入了1996年3月26日至12月31日期间开始使用利托那韦或茚地那韦治疗的所有患者。对患者进行艾滋病定义事件发生情况的评估。在基线和事件发生时记录临床评估、血浆HIV-1 RNA定量、CD4细胞计数。
共纳入486例患者：44.2%的患者CD4细胞计数低于50×10⁶个/升。46例患者记录了50次临床事件，平均随访6.1个月，其中34次事件（68%）在HAART治疗的前2个月观察到。其中18次事件发生时，病毒载量至少降低了1.5 log₁₀，且CD4细胞计数较事件发生时增加了100%，包括11例巨细胞病毒感染、5例分枝杆菌感染、1例隐球菌病和1例水痘-带状疱疹病毒相关的急性视网膜坏死。在第二个月后观察到的16次事件中，6次事件发生时尽管生物学指标有明显改善，其中6例停止维持治疗的患者中有5例复发。事件包括1例巨细胞病毒感染、2例分枝杆菌感染、1例食管念珠菌病发作和1例隐球菌性脑膜炎。
在开始HAART治疗方案前有发生机会性感染高风险的患者中，治疗的前2个月不应停止预防，且尽管CD4细胞计数显著增加仍应继续维持治疗。
