老年获得性免疫缺陷综合征住院患者226例临床特征分析

Clinical characteristics of 226 elderly acquired immunodeficiency syndrome inpatients

目的了解老年获得性免疫缺陷综合征(AIDS)住院患者临床特征,为该人群AIDS防治提供更精准的措施。方法收集2018年重庆市公共卫生医疗救治中心年龄≥60岁AIDS患者临床资料,回顾性分析人口学、免疫学、病毒学特征及合并机会性感染、慢性基础疾病发生情况。结果老年AIDS住院患者226例,男女比例5∶1,男性平均年龄(69.0±7.1)岁高于女性(65.4±6.1)岁(P=0.003),异性性传播感染者168例(74.3%)。66.8%(151/226)的患者有固定性伴侣,仅87例伴侣完成了人类免疫缺陷病毒(HIV)检测,其中28例(32.2%)呈阳性。全部患者平均CD4^(+)T淋巴细胞计数67(5~680)/μL、HIV-RNA(4.7±1.8)lg拷贝/mL。175例(77.4%)合并机会性感染,以真菌(47.3%)、细菌(40.7%)、结核分枝杆菌(36.3%)为主。190例(84.1%)患有慢性基础疾病,以高脂血症(75.2%)、糖尿病(17.7%)、高血压(16.4%)最常见。共156例(69.1%)好转出院。结论重庆地区老年AIDS住院患者以异性性传播为主,呈现高病毒载量及低免疫功能状况,患者常伴有慢性基础疾病,易合并多种机会性感染,出院好转率低。

Objective To review the clinical characteristics of elderly acquired immunodeficiency syndrome(AIDS)patients for precision prevention and treatment of AIDS.Methods The AIDS patients treated in Chongqing Public Health Medical Center during 2018 were searched to identify those aged at least 60 years.The clinical data were reviewed retrospectively,including demographic,immunological,virological results,incidence of opportunistic infection,and chronic underlying diseases.Results A total of 226 elderly AIDS patients were included(male/female ratio 5:1).The mean age of male patients was(69.0±7.1)years,significantly older than females(65.4±6.1)years(P=0.003).Heterosexual transmission was reported in 168 cases(74.3%).Most of the patients(66.8%)had regular sex partner.HIV testing result was available for 87 sex partners of these patients,showing positive result in 28(32.2%)cases.Overall,CD4^(+)T lymphocyte count was 67(5-680)/μL.HIV-RNA result was(4.7±1.8)lg copies/mL.Opportunistic infection was found in 175(77.4%)cases,the most common of which was fungal(47.3%,107/226),bacterial(40.7%,92/226),and tuberculosis(36.3%,82/226).Most patients(84.1%,190/226)had chronic underlying disease,primarily hyperlipidemia(75.2%),diabetes mellitus(17.7%),and hypertension(16.4%).More than half(69.1%,156/226)of the patients recovered and discharged.Conclusions Heterosexual transmission is the main route for the elderly to get AIDS.The elderly patients are characterized by high viral load and low immunity.Multiple opportunistic infections and chronic underlying diseases are found in most of the patients.Treatment compliance is poor for the elderly AIDS patients.