Effect of antiretroviral therapy on the incidence of bacterial pneumonia in patients with advanced HIV infection.
Effect of antiretroviral therapy on the incidence of bacterial pneumonia in patients with advanced HIV infection.
复制标题
抗逆转录病毒治疗对晚期 HIV 感染患者细菌性肺炎发生率的影响。
DOI：
10.1164/ajrccm.162.1.9904101
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发表时间：
2000
期刊：
影响因子：
--
通讯作者：
Chaisson,RE
中科院分区：
文献类型：
--
作者：
Sullivan,JH;Moore,RD;Keruly,JC;Chaisson,RE
为了确定联合抗逆转录病毒治疗与细菌性肺炎的关系，我们评估了1993年至1998年在约翰霍普金斯艾滋病诊所随访的1,898例CD 4细胞计数< 200/mm 3的人类免疫缺陷病毒（HIV）感染患者的细菌性肺炎发病率和危险因素。在2，310患者年的随访期间，共发生352例细菌性肺炎。细菌性肺炎的发病率从1993年上半年的22.7次/100人年（py）下降到1996年上半年的12.3次/100人年，1997年下半年达到最低点9.1次/100人年（p < 0.05）。使用含蛋白酶底物的治疗方案与细菌性肺炎风险降低相关（风险比[RR] 0.55，95% CI 0.31 - 0.94）。较低的CD 4细胞计数（RR 2.22，95% CI 1.54 - 3.18）、注射毒品作为HIV传播类别（RR 2.0，95% CI 1.43 - 2.76）和既往卡氏肺孢子虫（RR 3.88，95% CI 1.65 - 9.16）也与细菌性肺炎显著相关。甲氧苄啶-磺胺甲恶唑和大环内酯类药物的使用与细菌性肺炎的风险无显著相关性。由于使用含有蛋白酶抑制剂的抗逆转录病毒联合治疗，细菌性肺炎的发病率急剧下降。
To determine the relationship of combination antiretroviral therapy and bacterial pneumonia, we assessed incidence of and risk factors for bacterial pneumonia in 1,898 human immunodeficiency virus (HIV)-infected patients with CD4 cell counts < 200/mm3followed in the Johns Hopkins HIV clinic between 1993 and 1998. A total of 352 episodes of bacterial pneumonia occurred during 2,310 patient-years of follow-up. Incidence of bacterial pneumonia decreased from 22.7 episodes/100 person-years (py) in the first half of 1993 to 12.3 episodes/100 py in the first half of 1996, reaching a nadir of 9.1 episodes/100 py in the second half of 1997 (p < 0.05). The use of protease inhibitor–containing regimens was associated with a decreased risk of bacterial pneumonia (risk ratio [RR] 0.55, 95% CI 0.31 to 0.94). Lower CD4 cell counts (RR 2.22, 95% CI 1.54 to 3.18), injection drug use as HIV transmission category (RR2.0, 95% CI 1.43 to 2.76), and priorPneumocystis cariniipneumonia (RR 3.88, 95% CI 1.65 to 9.16) were also significantly associated with bacterial pneumonia. Trimethoprim-sulfamethoxazole and macrolide use were not significantly associated with risk of bacterial pneumonia. There has been a dramatic decline in the incidence of bacterial pneumonia resulting from the use of combination antiretroviral therapy containing protease inhibitors.