Sackoff J, McFarland J, Su S, Bryan E
New York City Department of Health, Office of AIDS Surveillance, New York 10013, USA.
J Acquir Immune Defic Syndr Hum Retrovirol. 1998 Dec 1;19(4):387-92. doi: 10.1097/00042560-199812010-00010.
In 1995 and 1997, the United States Public Health Service (USPHS) and the Infectious Disease Society of America (IDSA) published recommendations for primary prophylaxis of Pneumocystis carinii pneumonia (PCP), Mycobacterium avium complex (MAC), and toxoplasmosis in HIV-infected adults. We evaluated their implementation at four hospital-based HIV clinics in New York City in patients who initially met the CD4+ criterion for prophylaxis between January, 1995 and April, 1997. Medical records were reviewed at 6-month intervals to determine drugs prescribed. We identified 149 patients for the PCP sample, 130 for MAC, and 138 for toxoplasmosis. In the three samples, 91% were black and Hispanic, 75% to 81% were male, and 43% to 47% had a history of injection drug use (IDU); median age was between 39 and 40 years. PCP prophylaxis was prescribed during 93% of intervals and did not vary significantly by clinic or patient characteristics. Over the study period, MAC prophylaxis increased from 22% to 62%, and prescriptions for macrolides increased from 38% to 87% of all prescriptions. In the logistic regression analysis, prescription for MAC prophylaxis at any time during the study period was less likely in blacks compared with whites (odds ratio [OR] = .08; 95% confidence interval [CI] = .01, .52) and patients attending the clinic with the lowest rate of MAC prophylaxis (clinic D) compared with the clinic with the highest rate (clinic B; OR = .04; 95% CI = .01, .26). Toxoplasmosis prophylaxis was prescribed in 73% of intervals and did not differ significantly by antibody status (p = .42). Prescribing patterns were uniform across gender, HIV risk behavior, and age for PCP and MAC prophylaxis but differed by clinic and race for MAC prophylaxis. Trends in prophylaxis for opportunistic illnesses must continue to be monitored in light of the success of antiretroviral therapy in reducing the morbidity and mortality associated with HIV/AIDS.
1995年和1997年，美国公共卫生服务部（USPHS）和美国传染病学会（IDSA）发布了关于HIV感染成人原发性预防卡氏肺孢子虫肺炎（PCP）、鸟分枝杆菌复合体（MAC）和弓形虫病的建议。我们评估了1995年1月至1997年4月期间在纽约市四家医院的HIV诊所中，最初符合预防性治疗CD4+标准的患者对这些建议的实施情况。每隔6个月查阅病历以确定所开药物。我们确定了149例PCP样本患者、130例MAC样本患者和138例弓形虫病样本患者。在这三个样本中，91%为黑人和西班牙裔，75%至81%为男性，43%至47%有注射吸毒史（IDU）；中位年龄在39至40岁之间。93%的时间段开具了PCP预防性治疗药物，且不因诊所或患者特征而有显著差异。在研究期间，MAC预防性治疗从22%增加到62%，大环内酯类药物的处方在所有处方中的占比从38%增加到87%。在逻辑回归分析中，与白人相比，黑人在研究期间任何时候接受MAC预防性治疗的处方可能性较小（优势比[OR]=0.08；95%置信区间[CI]=0.01，0.52），与MAC预防性治疗率最高的诊所（诊所B）相比，在MAC预防性治疗率最低的诊所（诊所D）就诊的患者接受MAC预防性治疗的处方可能性较小（OR=0.04；95%CI=0.01，0.26）。73%的时间段开具了弓形虫病预防性治疗药物，且不因抗体状态而有显著差异（p=0.42）。PCP和MAC预防性治疗的处方模式在性别、HIV风险行为和年龄方面是一致的，但MAC预防性治疗在不同诊所和种族之间存在差异。鉴于抗逆转录病毒疗法在降低与HIV/AIDS相关的发病率和死亡率方面取得的成功，必须继续监测机会性疾病预防性治疗的趋势。
