Pneumonia associated with HIV infection.
Pneumonia associated with HIV infection.
复制标题
DOI：
10.1097/01.qco.0000160907.79437.5a
复制
发表时间：
2005-04-01
影响因子：
3.9
通讯作者：
Feldman, Charles
中科院分区：
文献类型：
--
作者：
Feldman, Charles
综述目的：肺炎常见于hiv感染患者，本文综述了近年来在该病的流行病学、发病机制、临床特征、治疗和预防方面的一些新发现。最近发现：肺炎仍然是hiv感染患者发病和死亡的重要原因。已经确定了许多增加肺炎风险的因素。吸烟增加了肺部定植的风险，以及由耶氏肺囊虫引起的急性肺炎，并且有文献记载，在hiv感染患者中，吸烟会显著抑制肺泡巨噬细胞的吞噬功能，这可能是这种风险的基础。嗜肺军团菌感染在艾滋病毒感染患者中似乎并不常见，而肺炎链球菌感染继续有规律地发生，包括抗生素耐药分离株感染。在接受HAART治疗的患者中，一旦CD4细胞计数增加到200微升以上，肺囊虫性肺炎的发生率较低。对侵袭性肺炎球菌感染（主要是肺炎）的研究表明，在危重病例中，包括艾滋病毒血清阳性患者，联合抗生素治疗的死亡率低于单一治疗。23价肺炎球菌疫苗已被证明可降低接受HAART治疗的艾滋病毒感染成人的肺炎球菌感染风险，而9价肺炎球菌结合疫苗已被证明可降低艾滋病毒血清阳性和艾滋病毒血清阴性儿童的放射学确诊肺炎发病率。摘要：肺炎仍然是艾滋病毒感染者的一个重要疾病，但最近的研究表明，抗生素预防、HAART的引入、对特定危险因素的认识、新的抗生素治疗策略和有效的疫苗应该有助于减少其影响。
PURPOSE OF REVIEW: Pneumonia occurs commonly in HIV-infected patients and this review highlights some of the recent findings in the epidemiology, pathogenesis, clinical features, treatment and prevention of this condition.RECENT FINDINGS: Pneumonia remains an important cause of morbidity and mortality in HIV-infected patients. A number of factors have been identified that increase the risk of pneumonia. Cigarette smoking increases the risk of lung colonization, as well acute pneumonia due to Pneumocystis jiroveci, and has been documented to produce significant depression of the phagocytic function of alveolar macrophages in HIV-infected patients, which may underlie this risk. Legionella pneumophila infections appear to be uncommon in HIV-infected patients, while pneumonia with Streptococcus pneumoniae continues to occur with regularity, including infections with antibiotic-resistant isolates. Pneumocystis pneumonia occurs with a low incidence in patients receiving HAART, once the CD4 count increases to over 200 microl. Studies of invasive pneumococcal infections (predominantly pneumonia) indicate that in critically ill cases, including HIV-seropositive patients, combination antibiotic therapy is associated with a lower mortality than monotherapy. The 23-polyvalent pneumococcal vaccine has been shown to reduce the risk of pneumococcal infection in HIV-infected adults receiving HAART, and a 9-valent conjugate pneumococcal vaccine has been shown to reduce the incidence of radiologically confirmed pneumonia in HIV-seropositive and HIV-seronegative children.SUMMARY: Pneumonia remains an important condition in HIV-infected patients, but recent studies demonstrate that antibiotic prophylaxis, the introduction of HAART, recognition of specific risk factors, new antibiotic treatment strategies and effective vaccines should serve to decrease its impact.