Penicilliosis and AIDS in Haiphong, Vietnam: Evolution and predictive factors of death
Penicilliosis and AIDS in Haiphong, Vietnam: Evolution and predictive factors of death
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DOI：
10.1016/j.medmal.2014.09.008
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发表时间：
2014-12-01
影响因子：
5
通讯作者：
Strobel, M.
中科院分区：
文献类型：
--
作者：
Son, V. T.;Khue, P. M.;Strobel, M.
目标。-本研究的目的是评估越南海防地区感染马尔尼菲青霉(Pm)的艾滋病患者的致死率和死亡的预测因素。-回顾2006年6月至2009年8月103例确诊病例的病历资料，进行回顾性队列研究。-青霉病相关死亡率很高(33%)。死亡的主要危险因素是：(1)缺乏完全治疗，同时接受伊曲康唑和抗逆转录病毒治疗(OR=5 2.2，P<0.001)；(2)仅接受过二级预防(OR=2 1.2，P<0.0 1)；(3)合并丙型肝炎(OR=2.3，P=0.0 2)和肺结核(OR=1.97，P=0.0 4)。ART后发生青霉病28例，可能由虹膜感染引起，其体征和症状与“普通”青霉病相同。然而，由于无法评估病毒载量，因此排除了IRIS的诊断。-青霉病在越南北部非常常见。对完全治愈的抗真菌治疗(两性霉素B)的良好依从性，然后结合抗逆转录病毒疗法(ART)的二级预防(伊曲康唑)，延长生存，防止复发，并允许在一半的病例中停止二级预防。(C)2014年爱思唯尔·马森公司。版权所有。
Objectives. - The study objective was to assess the lethality rates and the predictive factors for death in AIDS patients infected by Penicillium marneffei (Pm) in Hai Phong, Vietnam.Methods. - A retrospective cohort study was conducted by reviewing 103 medicals records of confirmed cases from June 2006 to August 2009.Results. - Penicilliosis-related mortality was very high (33%). The majors risk factors of death were: (i) patient lacking complete treatment, a regimen with both of secondary prophylaxis by itraconazole and HAART (OR = 52.2, P < 0.001); (ii) patients having received only secondary prophylaxis (OR = 21.2, P < 0.001); (iii) patients coinfected by hepatitis C (OR = 2.3, P = 0.02) and tuberculosis (OR = 1.97, P = 0.04). Penicilliosis occurred in 28 cases after initiation of ART, probably caused by IRIS, with the same signs and symptoms as "common" penicilliosis. However, the diagnosis of IRIS was ruled out because the viral load could not be assessed.Conclusions. - Penicilliosis is very frequent in the North of Vietnam. A good compliance to a complete treatment with healing antifungal (Amphotericin B) then secondary prophylaxis (Itraconazole) associate with ART, prolongs survival, prevents relapse, and also allows discontinuing a secondary prophylaxis in a half of the cases. (C) 2014 Elsevier Masson SAS. All rights reserved.