Epidemiologic changes in bacteremic pneumococcal disease in patients with human immunodeficiency virus in the era of highly active antiretroviral therapy
Epidemiologic changes in bacteremic pneumococcal disease in patients with human immunodeficiency virus in the era of highly active antiretroviral therapy
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DOI：
10.1001/archinte.165.13.1533
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发表时间：
2005-07-11
影响因子：
--
通讯作者：
Gudiol, F
中科院分区：
文献类型：
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作者：
Grau, I;Pallares, R;Gudiol, F
背景资料：使用高效抗逆转录病毒治疗（HAART）可能会改变发病率，风险和预后因素，侵袭性肺炎球菌疾病的患者与人类免疫缺陷病毒（HIV）。方法：我们前瞻性研究了142例肺炎球菌菌血症在122例HIV感染的成年人。85例发生在HAART前时代（1986-1996），57例发生在HAART时代（1997-2002）。进行了一项病例对照研究，以确定在HAART时代的肺炎球菌菌血症的危险因素。结果：肺炎球菌菌血症的发病率下降，从24.1发作每1000例患者-年在前HAART时代的8.2发作每1000例患者-年在HAART时代（P= 0.01）。与HAART治疗前相比，HAART治疗后患者的合并症更多（42% vs 26%; P= 0.04），菌血症复发更少（4% vs 15%; P= 0.04），30天死亡率更高（26% vs 8%; P= 0.004）。在这两个时期都观察到高抗生素耐药率。通过多因素分析，HAART时代肺炎球菌菌血症的主要危险因素是合并症（调整的比值比[OR]，3.36），酗酒（调整OR，5.28），既往住院（调整OR，3.38），目前吸烟（调整OR，5.19），CD 4细胞计数低于100个细胞/μ L（调整后OR，2.38）;而使用HAART（调整OR，0.37）和肺炎球菌疫苗结论：HAART和肺炎球菌疫苗的广泛应用可降低HIV感染者侵袭性肺炎球菌病的发生率。HAART时代肺炎球菌菌血症的危险因素和预后与非HIV感染者的报告更为相似。
Background: The use of highly active antiretroviral therapy (HAART) may change the incidence of, and the risk and prognostic factors for, invasive pneumococcal disease in patients with human immunodeficiency virus (HIV).Methods: We prospectively studied 142 episodes of pneumococcal bacteremia in 122 HIV-infected adults. Eighty-five episodes occurred in the pre-HAART era (1986-1996) and 57 in the HAART era (1997-2002). A case-control study was conducted to identify risk factors for pneumococcal bacteremia in the HAART era.Results: The incidence of pneumococcal bacteremia dropped from 24.1 episodes per 1000 patient-years in the pre-HAART era to 8.2 episodes per 1000 patient-years in the HAART era (P=.01). Compared with patients in the pre-HAART era, patients in the HAART era had more associated comorbiclity (42% vs 26%; P=.04), fewer recurrences of bacteremia (4% vs 15%; P=.04), and a higher 30-day mortality rate (26% vs 8%; P=.004). High antibiotic resistance rates were observed in both periods. By multivariate analysis, the major risk factors for pneumococcal bacteremia in the HAART era were associated comorbidity (adjusted odds ratio [OR], 3.36), alcohol abuse (adjusted OR, 5.28), prior hospitalization (adjusted OR, 3.38), current smoking (adjusted OR, 5.19), and CD4 cell count lower than 100 cells/mu L (adjusted OR, 2.38); while use of HAART (adjusted OR, 0.37) and pneumococcal vaccine (adjusted OR, 0.39) were protective factors.Conclusions: The widespread use of HAART and pneumococcal vaccine may decrease the incidence of invasive pneumococcal disease in HIV-infected patients. Risk factors and prognosis of pneumococcal bacteremia in the HAART era are more similar to those reported in non-HIV-infected individuals.