艾滋病合并隐球菌病临床诊疗的专家共识

Expert Consensus on the Diagnosis and Treatment of Cryptococcosis in AIDS Patients

隐球菌感染是艾滋病患者常见的机会性感染和致死原因.艾滋病患者感染隐球菌后常发展为不同类型的隐球菌病(cryptococcosis),依据感染性质和部位不同,可表现为隐球菌抗原血症、隐球菌性脑膜炎、肺部隐球菌病、皮肤隐球菌病及播散性隐球菌病等.与非HIV感染者隐球菌病不同,艾滋病合并隐球菌病患者病情重、治疗复杂、病死率高,发病机制与诊治各环节均具有一定特殊性,综合性、系统化的诊疗策略是降低病死率的关键.本共识在综合现有文献与课题研究成果基础上,就艾滋病合并隐球菌病的流行情况、发病机制、临床特征、诊断、抗真菌治疗与抗逆转录病毒治疗等内容进行详细阐述,以期为该疾病临床诊疗提供参考.

Different types of cryptococcosis often develop in HIV-infected patients when they are infected by Cryptococcus.Depending on the anatomical site and thenature of the infection,cryptococcosis may be classified into cryptococcal antigenemia,cryptococcal meningitis,pulmonary cryptococcosis,cutaneous cryptococcosis,disseminated cryptococcosis and others.Acquired immunodeficiency syndrome comorbid with cryptococcosis is a serious medical condition,causing high rates of associated mortality,and requires complex combination of antifungal therapeutic regimens involving induction,consolidation and maintenance phases of treatment,often for an extended period of time.Patients with cryptococcosis therefore require effective,comprehensive and systematic diagnostic and treatment strategies so as to reduce their mortality.This consensus document discusses the epidemiology,pathogenesis,clinical manifestations,diagnosis,treatment and prevention of cryptococcosis based on a combination of data extracted from existing literature and research results,and aims to provide a reference for the diagnosis and clinical management of cryptococcosis in HIV-infected patients.