HAART时代HIV/AIDS住院病人机会性感染疾病谱分析

Analysis of the opportunistic infections′spectrum in hospitalized patients with HIV/AIDS in the era of HAART

目的了解高效抗反转录病毒治疗（HAART）时代,住院艾滋病病毒（HIV）感染者/艾滋病（AIDS）病人（简称HIV/AIDS病人）机会性感染疾病谱的特征和变化。方法回顾性调查并分析2012年1月1日至2015年12月31日,在南宁第四人民医院感染病区的住院HIV/AIDS病人的人口学特征,实验室检查结果,机会性感染、合并疾病及预后等。结果共调查符合标准的住院HIV/AIDS病人6 222例,年龄中位数48岁,共诊断合并疾病19 712例次,其中机会性感染13 802次（70.02%）。细菌性肺炎（44.17%）、肺结核（34.73%）、口腔念珠菌感染（31.36%）、马尔尼菲青霉菌病（17.52%）、肺外结核（16.68%）、真菌性肺炎（14.27%）、肺孢子菌肺炎（8.65%）、巨细胞病毒感染（4.61%）、单纯疱疹（3,57%）、带状疱疹感染（3.23%）为病人住院治疗的主要机会性感染。非HIV相关疾病有电解质紊乱（14.51%）及肝功能异常（10.38%）、高血压及心脏病（7.23%）、乙型肝炎（6.49%）、皮炎（6.28%）等。HIV相关肿瘤有淋巴瘤65例、宫颈癌32例、卡波西肉瘤40例,非HIV相关肿瘤284例。住院期间死亡604例（9.71%）,自动出院608例（9.77%）,平均住院（17±26）日。住院前接受HAART有2 393例（38.46%）,治疗方案主要为拉米夫定（3TC）＋替诺福韦（TDF）＋依非韦仑（EFV）（13.37%）,齐多夫定（AZT）＋3TC＋EFV（11.99%）,AZT＋3TC＋奈韦拉平（NVP）（11.37%）。结论广西南部地区的HIV/AIDS病人住院原因主要为机会性感染,老年男性病人比率高。常见疾病为细菌性肺炎、肺结核、口腔念珠菌感染等,马尔尼菲青霉菌病有地域特色,需加强艾滋病防护知识宣教、早期筛查及纳入HAART。

Objective To understand the characteristics and changes of opportunistic infections in hospitalized patients with HIV/AIDS in HAART era.Methods The demographic characteristics,lab findings,opportunistic infections,complications and prognosis of hospitalized patients in the fourth people’s hospital of Nanning were retrospectively investigated and analyzed from January 1 st,2012 to December 31 th,2015.Results There were 6 222 HIV/AIDS patients during the period in the hospital,and the median age was 48 years old.19 712 case times of complications were diagnosed,including13 802（70.02%）opportunistic infections,with 44.17% of bacterial pneumonia,34.73% of pulmonary tuberculosis,31.36% of oral candidiasis,17.52% of penicillium marneffei,16.68% of extrapulmonary tuberculosis,14.26% of fungal pneumonia,8.65% of pneumocystis pneumonia,4.61% of cytomegalovirus infection,3.57% of herpes simplex and3.23% of herpes zoster.Electrolyte disorders（14.51%）and abnormal liver function（10.38%）,hypertension and heart disease（7.23%）,hepatitis B（6.49%）,dermatitis（6.28%）were the main comorbidities.Common tumors included 65 cases of lymphoma,32 cases of cervical cancer,40 cases of Kaposi’s sarcoma,and 284 cases of non-HIV-related tumors.There were 604（9.71%）deaths and 608（9.77%）patients left voluntarily during hospitalization, with average hospitalization as 17±26 days.2 393（38.46%）patients received HAART before hospital admission and the HAART programme mainly contained 3 TC＋TDF＋EFV（13.37%）,AZT＋3 TC＋EFV（11.99%）,AZT＋3 TC＋NVP（11.37%）.Conclusion The most frequent cause of hospitalization for HIV/AIDS patients in the Southern Guangxi are opportunistic infections,with a high rate of elderly male patients.Penicillium marneffei has geographical features while pneumocystis pneumonia and cytomegalovirus are different from those of the northern region.