Opportunistic infections among individuals with HIV-1/AIDS in the highly active antiretroviral therapy era at a Quaternary Level Care Teaching Hospital

INTRODUCTION : In this study, clinical-laboratory and epidemiological characteristics are described for a group of 700 individuals with HIV (human immunodeficiency virus)/AIDS (acquired immunodeficiency syndrome) in the ART (antiretroviral therapy) era at a teaching hospital that provides a quaternary level of care, with an emphasis on opportunistic infections (OIs), co-infections and immune profile. METHODS : A retrospective cross-sectional study of AIDS cases was conducted from 1998 to 2008 by reviewing medical records from the Base Hospital/FUNFARME (Fundação Faculdade Regional de Medicina), São José do Rio Preto, São Paulo, Brazil. RESULTS: The individuals were 14 to 75 years of age, and 458 were males. Heterosexuals accounted for 31.1% of all patients. Eighty-three percent were on ART, and 33.8% of those presented difficulties with treatment adherence. OIs were analyzed from medical records, and Pneumocystis jiroveci pneumonia was the most prevalent, regardless of the LTCD4+ (TCD4+ Lymphocytes) levels. Individuals whose viral loads were ≥10,000 showed a 90% greater chance of neurotoxoplasmosis. For P. jiroveci pneumonia, neurotoxoplasmosis, esophageal candidiasis, pulmonary tuberculosis and neurocryptococcosis, the chances of infection were higher among patients with LTCD4+ levels below 200 cells/mm3. HIV/hepatitis C virus (HCV) and HIV/hepatitis B virus (HBV) co-infections were significantly associated with death. CONCLUSIONS : OIs remain frequent in the ART era even in populations where the access to medical care is considered satisfactory.

引言：本研究针对巴西圣保罗州圣若泽杜里约普雷图市一所提供四级医疗服务的教学医院内，抗逆转录病毒治疗（antiretroviral therapy, ART）时代下的700名人类免疫缺陷病毒（human immunodeficiency virus, HIV）/获得性免疫缺陷综合征（acquired immunodeficiency syndrome, AIDS）患者，描述其临床实验室与流行病学特征，重点关注机会性感染（opportunistic infections, OIs）、合并感染及免疫特征。方法：本研究为回顾性横断面研究，通过查阅巴西圣保罗州圣若泽杜里约普雷图市Base Hospital/FUNFARME（区域医学基金会学院，Fundação Faculdade Regional de Medicina）的医疗记录，纳入1998年至2008年的艾滋病病例开展分析。结果：研究对象年龄介于14至75岁之间，其中458名为男性。异性恋感染者占所有患者的31.1%。83%的患者接受了抗逆转录病毒治疗，其中33.8%存在治疗依从性障碍。研究通过医疗记录分析机会性感染情况，耶氏肺孢子菌肺炎（Pneumocystis jiroveci pneumonia）为最常见的机会性感染，与CD4+ T淋巴细胞（LTCD4+）水平无关。病毒载量≥10000的患者患神经弓形虫病的风险升高90%。对于耶氏肺孢子菌肺炎、神经弓形虫病、食管念珠菌病、肺结核及神经隐球菌病，CD4+ T淋巴细胞计数低于200个/mm³的患者感染风险显著升高。人类免疫缺陷病毒/丙型肝炎病毒（hepatitis C virus, HCV）及人类免疫缺陷病毒/乙型肝炎病毒（hepatitis B virus, HBV）合并感染与患者死亡显著相关。结论：即使在医疗可及性被认为较为良好的人群中，机会性感染在抗逆转录病毒治疗时代仍较为常见。