CLINICAL MANIFESTATIONS OF AIDS IN THE ERA OF PNEUMOCYSTIS PROPHYLAXIS
CLINICAL MANIFESTATIONS OF AIDS IN THE ERA OF PNEUMOCYSTIS PROPHYLAXIS
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DOI：
10.1056/nejm199312233292604
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发表时间：
1993-12-23
影响因子：
158.5
通讯作者：
KASLOW, RA
中科院分区：
文献类型：
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作者：
HOOVER, DR;SAAH, AJ;KASLOW, RA
背景在感染人类免疫缺陷病毒1型（HIV-1）的患者中，早期和广泛使用卡氏肺孢子虫的预防方案正在改变与获得性免疫缺陷综合征（AIDS）相关的疾病模式。我们对来自2592名HIV-1感染的同性恋男性的844名男性艾滋病患者（其中87%已经死亡）进行了一项亚队列分析。共有138名男性在诊断艾滋病之前接受了预防，但39名（28%）在某个时候患有卡氏肺孢子虫肺炎。在艾滋病发病前接受卡氏肺孢子虫预防的男性中，只有四种疾病的发病率更高：鸟分枝杆菌复合体病，发病率为33.4%，而在706名未接受早期预防的男性中，发病率为17.3%;（18.4%对6.4%）;巨细胞病毒病（44.9%对24.8%）;食管念珠菌病（21.3%对12.8%）。总的来说，这四种疾病占艾滋病发病前接受预防的人中42.7%的最初与艾滋病有关的疾病，而没有接受预防的人中有10.7%。在艾滋病诊断前的三个6个月期间（0 - 6个月、>6 - 12个月和>12 - 18个月），接受卡氏肺孢子虫预防治疗的男性的几何平均CD 4+细胞计数分别为48、87和147/mm 3，而未接受预防治疗的男性分别为118、211和279/mm 3。M.禽复合体病、食管念珠菌病、消耗综合征和巨细胞病毒病在接受卡氏肺孢子虫预防治疗的HIV感染患者中比在未接受预防治疗的患者中更常见。预防措施可将首次感染艾滋病的时间推迟6至12个月。
Background. Among patients infected with human immunodeficiency virus type 1 (HIV-1), early and widespread use of prophylactic regimens against Pneumocystis carinii is changing the pattern of illnesses related to the acquired immunodeficiency syndrome (AIDS).Methods. We conducted a subcohort analysis of 844 men with AIDS (87 percent of whom have since died) from a prospectively followed cohort of 2592 HIV-1-infected homosexual men.Results. A total of 138 men received prophylaxis before the diagnosis of AIDS, but 39 (28 percent) nevertheless had P. carinii pneumonia at some time. Only four illnesses occurred more frequently in men who received P. carinii prophylaxis before the onset of AIDS: Mycobacterium avium complex disease, which developed in 33.4 percent, as compared with 17.3 percent of the 706 men who did not receive early prophylaxis; wasting syndrome (18.4 percent vs. 6.4 percent); cytomegalovirus disease (44.9 percent vs. 24.8 percent); and esophageal candidiasis (21.3 percent vs. 12.8 percent). Collectively, these four diseases accounted for the initial AIDS-related illness in 42.7 percent of those who received prophylaxis before the onset of AIDS, as compared with 10.7 percent of those who did not. During the three 6-month periods before the diagnosis of AIDS (0 to 6, >6 to 12, and >12 to 18 months), the geometric mean CD4+ cell counts were 48, 87, and 147 per cubic millimeter, respectively, in men who received prophylaxis against P. carinii, as compared with 118, 211, and 279 per cubic millimeter in those who did not.Conclusions. M. avium complex disease, esophageal candidiasis, wasting syndrome, and cytomegalovirus disease are more common in HIV-infected patients who have received prophylaxis against P. carinii than in those who have not. Prophylaxis may delay the first AIDS illness for 6 to 12 months.