Trends in Hospitalizations for AIDS-Associated Pneumocystis jirovecii Pneumonia in the United States (1986 to 2005)
Trends in Hospitalizations for AIDS-Associated Pneumocystis jirovecii Pneumonia in the United States (1986 to 2005)
复制标题
DOI：
10.1378/chest.08-2859
复制
发表时间：
2009-07-01
期刊：
影响因子：
9.6
通讯作者：
Holguin, Fernando
中科院分区：
文献类型：
--
作者：
Kelley, Colleen F.;Checkley, William;Holguin, Fernando
背景资料：虽然自从引入化学预防和有效的联合抗逆转录病毒疗法（ART）以来，美国因艾滋病相关的肺孢子虫肺炎（PCP）住院的人数有所减少，但PCP仍然是AIDS患者患病和死亡的重要原因。方法：我们使用1986年至2005年的全国出院调查分析了艾滋病相关PCP出院的趋势。1986年至2005年期间，估计有5.39亿患者出院，其中估计有312，411人患有艾滋病相关的PCP。出院的艾滋病相关PCP患者比例从采用化学预防前的31%（1986 - 1989年）降至采用化学预防后的17%（1990 - 1995年），随后降至1996年采用抗逆转录病毒疗法后的9%（p < 0.001）。在这三个时间段之间，艾滋病相关PCP的死亡率从21%降至16%，随后降至7%（p < 0.001）。在接受机械通气的患者中，死亡率从化疗前的79%下降到ART时代的31%（p < 0.001），同时机械通气的使用率增加（从5%增加到11%）。我们还观察到，随着时间的推移，PCP风险人群发生了变化：黑人、妇女和来自南方各州的人受到影响的比例更高（所有p < 0.001）。虽然在过去20年中，艾滋病相关PCP的住院率和住院死亡率显著下降，这些减少在人口亚群和地理区域之间并不均匀，并表明出现了新的高危人群。此外，需要机械通气的严重PCP病例的死亡率已大幅改善。（CHEST 2009; 136：190-197）
Background: Although hospitalizations for AIDS-associated Pneumocystis jirovecii pneumonia (PCP) in the United States have decreased since the introduction of chemoprophylaxis and potent combination antiretroviral therapy (ART), PCP remains an important cause of illness and death among AIDS patients.Methods: We analyzed trends in AIDS-associated PCP hospital discharges using the National Hospital Discharge Surveys between 1986 and 2005.Results: An estimated 539 million patients were discharged from hospitals between 1986 and 2005, of whom an estimated 312,411 had AIDS-associated PCP. The proportion of patients discharged from the hospital with AIDS-associated PCP decreased from 31% before the introduction of chemoprophylaxis (1986 to 1989) to 17% with chemoprophylaxis (1990 to 1995) and subsequently to 9% after the introduction of ART in 1996 (p < 0.001). Mortality from AIDS-associated PCP decreased from 21 to 16% and subsequently to 7% between these three time periods (p < 0.001). Among those who received mechanical ventilation, mortality decreased from 79% in the prechemoprophylaxis era to 31% in the ART era (p < 0.001) alongside an increase (from 5 to 11%) in the use of mechanical ventilation. We also observed a shift in the population at-risk for PCP over time: a greater proportion of black people, women, and people from Southern states were affected (all p < 0.001).Conclusions: While there have been significant reductions in hospitalizations and hospital mortality for AIDS-associated PCP over the last 20 years, these reductions have not been homogenous across demographic subpopulations and geographic regions and point to new at-risk populations. Furthermore, mortality in severe cases of PCP that require mechanical ventilation has improved substantially. (CHEST 2009; 136:190-197)