THE RISK OF PNEUMOCYSTIS-CARINII PNEUMONIA AMONG MEN INFECTED WITH HUMAN IMMUNODEFICIENCY VIRUS TYPE-1
THE RISK OF PNEUMOCYSTIS-CARINII PNEUMONIA AMONG MEN INFECTED WITH HUMAN IMMUNODEFICIENCY VIRUS TYPE-1
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DOI：
10.1056/nejm199001183220304
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发表时间：
1990-01-18
影响因子：
158.5
通讯作者：
SAAH, A
中科院分区：
文献类型：
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作者：
PHAIR, J;MUNOZ, A;SAAH, A
我们在多中心艾滋病队列研究中评估了1665名人类免疫缺陷病毒1型（HIV-1）血清阳性但未患获得性免疫缺陷综合征（艾滋病）且未接受卡氏肺囊虫预防治疗的参与者因卡氏肺囊虫引起肺炎的风险。在48个月的随访中，168名参与者（10.1%）首次出现卡氏假体肺炎。CD4+细胞计数基线为每立方毫米200或更少的参与者的风险大大增加（相对风险，4.9；95%置信区间，3.1至8.0）。尽管大多数参与者（60.7%）在首次注意到CD4+细胞计数为每立方毫米200或更少的诊所就诊时没有描述hiv -1相关症状，但随访期间的这一发现也与卡氏疟原虫肺炎的风险增加有关。鹅口疮或发热显著且独立地增加了这些患者卡氏假体肺炎的风险（调整后的相对风险，鹅口疮和发热分别为1.86和2.15）。大多数CD4+细胞计数高于200 /立方毫米的参与者在六个月内患有卡氏假体肺炎。我们的结论是，卡氏疟原虫肺炎不太可能在hiv -1感染的患者中发展，除非他们的CD4+细胞减少到每立方毫米200或以下，或者患者有症状，因此应该为这类患者保留预防措施。
We assessed the risk of pneumonia due to Pneumocystis carini in 1665 participants in the Multicenter AIDS Cohort Study who were seropositive for human immunodeficiency virus type 1 (HIV-1) but did not have the acquired immunodeficiency syndrome (AIDS) and were not receiving prophylaxis against P. carinii. During 48 months of follow-up, 168 participants (10.1 percent) had a first episode of P. carinii pneumonia. The risk was greatly increased in participants with CD4+ cell counts at base line of 200 per cubic millimeter or less (relative risk, 4.9; 95 percent confidence interval, 3.1 to 8.0). Although most participants (60.7 percent) described no HIV-1-related symptoms at the clinic visit at which a CD4+ cell count of 200 per cubic millimeter or less was first noted, this finding during follow-up was also associated with an increased risk of P. carinii pneumonia. The development of thrush or fever significantly and independently increased the risk of P. carinii pneumonia in these patients (adjusted relative risk, 1.86 and 2.15 for thrush and fever, respectively). Most participants with CD4+ cell counts above 200 per cubic millimeter who had P. carinii pneumonia within six months were symptomatic. We conclude that P. carinii pneumonia is unlikely to develop in HIV-1-infected patients unless their CD4+ cells are depleted to 200 per cubic millimeter or below or the patients are symptomatic, and therefore that prophylaxis should be reserved for such patients.