HIV感染患者特别容易患侵袭性肺炎球菌病(IPD)。我们描述了HIV/AIDS患者(PLWHA)的IPD病例,并发现了感染和死亡的相关危险因素。
方法:回顾性病例对照研究,嵌套在队列中,包括有和没有IPD的PLWHA,在巴西进行,2005-2020年。对照组与病例的性别/年龄相同,并在同一时间/地点观察。
结果:我们在45例患者和108例对照中发现了55例IPD(病例)。IPD的发病率为964/100,000人年。55例IPD发作中有42例(76.4%)出现肺炎,11例(20%)出现菌血症,无病灶,38/45例(84.4%)住院。血培养阳性54/55(98.2%)。在单因素分析中,肝硬化和COPD是与PLWHA中IPD相关的唯一因素,尽管在多变量分析中没有发现相关因素。4/45(8.9%)对青霉素耐药。关于抗逆转录病毒疗法(ART),40/45(88.9%)病例与80/102个对照(74.1%)在使用中(p=0.07)。与对照组相比,HIV和IPD患者的CD4计数较高,为267细胞/mm3,其中140个细胞/mm3(p=0.027)。记录了19%的肺炎球菌疫苗接种。酒精中毒(p=0.018),肝硬化(p=0.003),和较低的最低点CD4计数(p=0.033)与IPD患者的死亡风险相关。PLWHA和IPD的住院死亡率为21.1%,它与血小板减少症和低蛋白血症有关,升高的带形式,肌酐,和天冬氨酸氨基转移酶(AST)。
结论:尽管进行了ART治疗,PLWHA中IPD的发生率仍然很高。疫苗接种率低。肝硬化与IPD和死亡相关。
HIV-infected patients are at particular risk for invasive pneumococcal disease (IPD). We describe cases of IPD in people living with HIV/AIDS (PLWHA) and find associated risk factors for infection and death.
METHODS: A retrospective
case-control study, nested in a cohort, including PLWHA with and without IPD, conducted in Brazil, 2005-2020. Controls were of the same gender/age and seen at the same time/place as cases.
RESULTS: We identified 55 episodes of IPD (cases) in 45 patients and 108 controls. The incidence of IPD was 964/100,000 person-years. A total of 42 of 55 (76.4%) IPD episodes presented with pneumonia and 11 (20%) with bacteremia without a focus and 38/45 (84.4%) were hospitalized. Blood cultures were positive in 54/55 (98.2%). Liver cirrhosis and COPD were the only factors associated with IPD in PLWHA in univariate analysis, although no associated factors were found in multivariate analysis. Penicillin resistance was found in 4/45 (8.9%). Regarding antiretroviral therapy (ART), 40/45 (88.9%) cases vs. 80/102 controls (74.1%) were in use (p = 0.07). Patients with HIV and IPD had a higher CD4 count of 267 cells/mm3 compared with the control group, in which it was 140 cells/mm3 (p = 0.027). Pneumococcal vaccination was documented in 19%. Alcoholism (p = 0.018), hepatic cirrhosis (p = 0.003), and lower nadir CD4 count (p = 0.033) were associated with the risk of death in patients with IPD. In-hospital mortality among PLWHA and IPD was 21.1%, and it was associated with thrombocytopenia and hypoalbuminemia, elevated band forms, creatinine, and aspartate aminotransferase (AST).
CONCLUSIONS: The incidence of IPD in PLWHA remained high despite ART. The vaccination rate was low. Liver cirrhosis was associated with IPD and death.