Cryptosporidiosis among patients infected with human immunodeficiency virus - Factors related to symptomatic infection and survival
Cryptosporidiosis among patients infected with human immunodeficiency virus - Factors related to symptomatic infection and survival
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DOI：
10.1093/oxfordjournals.aje.a009015
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发表时间：
1996-11-01
影响因子：
5
通讯作者：
Petersen, C
中科院分区：
文献类型：
--
作者：
Colford, JM;Tager, IB;Petersen, C
作者回顾了 1986 年至 1992 年期间旧金山综合医院 194 名新诊断为隐孢子虫病的人类免疫缺陷病毒 (HIV) 阳性患者和所有 3,564 名新诊断的获得性免疫缺陷综合征 (AIDS) 患者的医疗记录。该研究旨在解决三个问题：1）患有隐孢子虫病的艾滋病患者与其他艾滋病患者有何不同？ 2) 哪些因素与新诊断的隐孢子虫病艾滋病患者的生存相关？ 3) 隐孢子虫病的诊断是否会影响艾滋病诊断后的生存？研究期间共发现 194 例 HIV 感染者隐孢子虫病病例。在这 194 名患者中，有 109 名（56%）之前没有诊断出艾滋病。这109名患者占同期新诊断艾滋病病例3564例的3.1%。在隐孢子虫诊断后 3 个月内进行 CD4 T 淋巴细胞计数的 134 名患者中，34 名 (25%) 的 CD4 计数大于 209 个细胞/ml。在多变量条件逻辑回归模型中，隐孢子虫的发病率与种族（对于黑人与白人，匹配比值比 (OR) = 0.15，95% 置信区间 (CI) 0.03-0.73）、CD4 计数（对于小于或等于 53 个细胞/ml 与 >53 个细胞/ml 的 CD4 计数，匹配 OR = 12.60，95% CI 4.01-39.61）和年龄（10 年增长，匹配 OR = 0.51，95% CI 0.27-0.98）。在比例风险模型中，诊断隐孢子虫时测量的两个因素被确定为与生存独立相关 (p < 0.001)：CD4 计数小于或等于 53 个细胞/ml 与 >53 个细胞/ml（相对风险 = 6.18，95% CI 2.99-12.76）和血细胞比容小于或等于 37% 与 >37%（相对风险 = 2.27， 95% CI 1.22-4.22）。由这两个变量定义的隐孢子虫感染患者的四个亚组的中位生存期彼此显着不同（范围为 204-1,119 天）。与其他艾滋病定义诊断相比，隐孢子虫病作为初始艾滋病定义诊断与死亡相对风险升高相关（相对风险 = 2.01，95% CI 1.38-2.93）。这些数据确定了有可能出现有症状的隐孢子虫感染风险的艾滋病毒感染者群体；已感染这种寄生虫的患者亚组之间的不同生存模式；以及新诊断的隐孢子虫病艾滋病患者相对于患有其他艾滋病定义病症的患者的生存率。这些信息对于设计前瞻性研究、制定预防策略、评估候选疗法以及向患者提供预后信息是必要的。
The authors reviewed the medical records of 194 human immunodeficiency virus (HIV)-positive patients newly diagnosed with cryptosporidiosis and all 3,564 patients with newly diagnosed acquired immunodeficiency syndrome (AIDS) at San Francisco General Hospital for the period 1986-1992. The study was designed to address three questions: 1) How do AIDS patients who present with cryptosporidiosis differ from other patients with AIDS? 2) What factors are associated with survival among AIDS patients with newly diagnosed cryptosporidiosis? 3) Does a diagnosis of cryptosporidiosis impact survival after AIDS diagnosis? A total of 194 cases of cryptosporidiosis among HIV-infected patients were identified during the study period. Of the 194 patients, 109 (56%) had no prior diagnosis of AIDS. These 109 patients represented 3.1% of the 3,564 newly diagnosed cases of AIDS in the same period. Among the 134 patients with CD4 T-lymphocyte counts performed within 3 months of Cryptosporidium diagnosis, 34 (25%) had CD4 counts greater than 209 cells/ml. In a multivariate conditional logistic regression model, the incidence of Cryptosporidium was related to ethnicity (for blacks vs. whites, matched odds ratio (OR) = 0.15, 95% confidence interval (CI) 0.03-0.73), CD4 count (for a CD4 count of less than or equal to 53 cells/ml vs. >53 cells/ml, matched OR = 12.60, 95% CI 4.01-39.61), and age (for a 10-year increase, matched OR = 0.51, 95% CI 0.27-0.98). Two factors measured at the time of Cryptosporidium diagnosis were identified as being independently associated with survival (p < 0.001) in the proportional hazards model: CD4 count less than or equal to 53 cells/ml versus >53 cells/ml (relative hazard = 6.18, 95% CI 2.99-12.76) and hematocrit less than or equal to 37% versus >37% (relative hazard = 2.27, 95% CI 1.22-4.22). The median durations of survival in the four subgroups of Cryptosporidium-infected patients defined by these two variables differed significantly from each other (range, 204-1,119 days). Cryptosporidiosis as an initial AIDS-defining diagnosis was associated with an elevated relative hazard of death in comparison with other AIDS-defining diagnoses (relative hazard = 2.01, 95% CI 1.38-2.93). These data identify the groups of HIV-infected individuals at risk for presentation with symptomatic Cryptosporidium infection; the distinct survival patterns among subgroups of those patients already infected with this parasite; and the survival of AIDS patients with newly diagnosed cryptosporidiosis relative to patients with other AIDS-defining conditions. Such information is necessary for the design of prospective studies, the development of prophylactic strategies, the evaluation of candidate therapies, and the provision of prognostic information to patients.