艾滋病合并机会性感染63例临床分析

目的：整理分析63例艾滋病患者机会性感染的疾病谱,总结其临床特点以及高效抗反转录病毒治疗（highly active antiretrovivaltherapy,HAART）与患者疾病转归的关系。方法：采用回顾性分析的方法对63例艾滋病合并机会性感染的相关信息进行临床分析。结果：63例患者首发临床症状前三位依次为发热、咳嗽、消瘦。机会性感染以细菌、病毒和真菌感染为主,其中肺结核31例,卡氏肺孢子菌肺炎25例,细菌性肺炎12例,口腔念珠菌感染16例,细菌性肠炎10例,慢性乙型肝炎14例,慢性丙型肝炎24例,胆囊炎6例,带状疱疹3例,药疹2例,血管闭塞性脉管炎2例,其余感染均为1例。死亡7例,病死率11.11%。结论：艾滋病机会性感染种类多,临床表现复杂多样。高效抗反转录病毒治疗可以使艾滋病患者免疫系统得到部分重建,减少机会性感染的发生。     

The essence of infection by opportunistic microorganisms

Infection is regarded as an imbalance between microbial pathogenicity factors and the host defense systems. Opportunistic infections are defined as infections rarely observed in humans with normal immune responses. The term immunocompromised (compromised) host refers to host in which one or more defence mechanisms are inactive and in which the probability of infection is therefore increased. Hospital patients are often compromised host. Compromised hosts exist even outside the hospital (smoking, intravenous drug use, poor nutrition and other). A good example is HIV (human immunodeficiency virus). HIV causes acquired immunodeficiency syndrome (AIDS) by destroying the CD4 T lymphocytes, involved in the immune response. The most common AIDS-associated opportunistic infections include pneumonia caused by the fungus Pneumocystis carinii, systemic candidiasis (Candida albicans) and cryptococcosis (Cryptococcus neoformans), protozoal infections such as cryptosporidiosis (Cryptosporidium spp.) and toxoplasmosis (Toxoplasma gondii), viral infections due to HSV, CMV, EBV, HPV or HHV8, tuberculosis and other bacterial infections. Pneumocystis carinii pneumonia (PCP) is the most common opportunistic disease observed in AIDS patients. Disease does not necessarily follow exposure to a given causal agent (pathogen 01 opportunistic pathogen). In fact, the occurrence (or otherwise) of disease typically depends on various factors--including the degree of sensitivity of the host (as above) and the virulence factors of the pathogens. Overtly aggressive products such as toxins and aggressins are clearly virulence factors. However, so too are those products and strategies which help a pathogen to become established in the host and to evade the host's defences. Certain virulence factors can be induced in the pathogen via signal transduction pathways from environment.     

AIDS in Tunisian women. Study of 92 cases

The authors report a retrospective study about 92 cases of HIV-1 infections among adult tunisian women hospitalised or consulting in the department of infectious diseases at Rabta hospital over a period of 15 years and 6 months. The middle age is 33.2 years. 64.1% of patients are married, and the conjoint is HIV-1 positive in 84.1% of cases. The route of transmission is sexual in 75%, parenteral in 22.8% and unknown in 2.2%. According to CD4 level and clinical symptoms, patients are at AIDS stage in 75.5%. The main clinical symptoms are: oral candidiasis in 92.4%, diarrhea in 54.3%, pneumocystis carinii pneumoniae in 11.9%, cerebral toxoplasmosis in 10.9%, septicemia caused particularly by salmonella in 9.7%, tuberculosis in 6.7%, cryptococcal meningitis in 4.3% an Kaposi's sarcoma in 3.2%. Mother to child HIV transmission is found in 33.3%, and the mortality is noted in 43.5% of cases.     

Incidence of primary opportunistic infections in two human immunodeficiency virus-infected French clinical cohorts

BACKGROUND: Clinical guidelines for the prevention of opportunistic infections in human immunodeficiency virus (HIV)-infected individuals have been developed on the basis of natural history data collected in the USA. The objective of this study was to estimate the incidence of primary opportunistic infections in HIV-infected individuals in geographically distinct cohorts in France. METHODS: We conducted our study on 2664 HIV-infected patients from the Tourcoing AIDS Reference Centre and the hospital-based information system of the Groupe d'Epidémiologie Clinique du SIDA en Aquitaine enrolled from January 1987 to September 1995 and followed through December 1995. We estimated: (1) CD4-adjusted incidence rates of seven primary opportunistic infections in the absence of prophylaxis for that specific infection or any antiretroviral drugs other than zidovudine; and (2) CD4 lymphocyte count decline. RESULTS: The highest incidence rates for all opportunistic infections studied occurred in patients with CD4 counts < 200/microl. With CD4 counts < 50/microl, the most common opportunistic infections were toxoplasmic encephalitis (12.6 per 100 person-years) and Pneumocystis carinii pneumonia (11.4 per 100 person-years). Mycobacterium tuberculosis was the least common opportunistic infection (< 5.0/100 person-years). Even with CD4 counts > 300/microl, cases of Pneumocystis carinii pneumonia and toxoplasmic encephalitis were reported. The mean CD4 lymphocyte decline per month was 4.6 cells/microl. There was a significant association between HIV risk behaviour and the incidence of cytomegalovirus infection, between calendar year and the incidence of Pneumocystis carinii pneumonia, toxoplasmic encephalitis and Candida esophagitis, and between geographical area and the incidence of Pneumocystis carinii pneumonia and cytomegalovirus infection. CONCLUSIONS: Geographical differences exist in the incidence of HIV-related opportunistic infections. These results can be used to define local priorities for prophylaxis of opportunistic infections.     

Managing illness

Although most infants infected with HIV manifest no symptoms of their infected status at birth, HIV-infected children usually develop clinical signs of HIV/AIDS much sooner after infection than do adults. A small percentage of children manifest no signs of HIV infection until reaching age 10 years or older. More than half of all HIV-infected children live for more than 5 years. It is extremely important that HIV-infected children lead normal lives, being allowed to play with friends, go to school, and play sports. Such children cannot transmit HIV to others through everyday activities. HIV status need not be known for the majority of infections an HIV-infected child is likely to have. Rather, such children need the same preventative care as all children, including routine immunization, good nutrition, basic hygiene, the prompt treatment of illnesses, and regular growth monitoring. Common illnesses in children with HIV infection include candidiasis, recurrent fever, recurrent bacterial infections, persistent diarrhea, chronic cough, and skin diseases. HIV-specific illnesses include pneumocystis carinii pneumonia, cerebral toxoplasmosis, and cryptococcal meningitis. Supportive care should be provided to sick children to relieve symptoms and reduce pain.     

AIDS and Africa

This article describes the AIDS situation in Africa and pinpoints the differences, so far as they are known, between that continent and the US and Europe. There is currently evidence of infection in up to 15% of the general urban population of some African countries, although it is impossible to estimate the total number of cases. Among San Francisco homosexuals who are sero-positive, about 1/3 are expected to develop AIDS within 5 years; among infected newborns the development of AIDS is even faster. In Africa, preliminary work suggests 1% of symptomless HIV-positive people will develop AIDS each year; and 10% will develop the AIDS-related complex (ARC). The most important mode of transmission in Africa is heterosexual transmission. The sero-prevalence among prostitutes is extremely high, which suggests that they play a crucial role in transmission of the disease. Such factors as the high level of sexually transmitted disease in Africa may facilitate heterosexual spread, in contrast to the US and Europe where spread is higher among homosexuals. So far, little evidence supports the fear that inadequately sterilized needles and syringes could facilitate transmission. Insects do not transmit AIDS. Since latent infections vary with environment, it is not suprising that there are major differences in the incidence of opportunistic infections in AIDS patients from Africa and Europe or the US; pneumocystis carinii pneumonia and Mycobacterium avium-intracellulare infections are common in the West, while in Africa there is a high incidence of tuberculosis, candidiasis, toxoplasmosis and infection with cryptosporidia, isospora and cryptococcus. Kaposi's sarcoma has long been known to exist in Africa in its endemic form, normally causing chronic nodules on the lower legs. However, a new aggressive form has been recognized in AIDS patients which is more metastatic and invasive. Although research is promising, the only immediate practical step is prevention of the spread of AIDS by changes in sexual behavior, in particular a reduction in the numbers of sexual partners and the use of condoms.     

Generalized histoplasmosis in 3 patients with an HIV infection

Three patients with generalized histoplasmosis and the acquired immunodeficiency syndrome (AIDS) are described. Symptoms of generalized histoplasmosis in patients with AIDS are not specific and concomitant opportunistic infections frequently occur. Two patients suffered from an infection by Mycobacterium tuberculosis, one patient had Pneumocystis carinii pneumonia, and one had cerebral toxoplasmosis. One patient had serological results positive for Histoplasma capsulatum. Two of the three patients showed rapid clinical improvement on amphotericin B but this was temporary and all patients died within 5 months.     

艾滋病100例临床分析与机会感染治疗转归

目的了解艾滋病的临床特点、并发症及其治疗效果。方法回顾性分析某院住院的100例艾滋病患者的临床资料。结果100例艾滋病患者主要临床表现为:消瘦、发热、贫血、咳嗽咳痰、腹痛腹泻、胸闷气促、肝大、淋巴结肿大;主要并发症为机会性感染和继发性肿瘤,居前6位的感染分别是口腔念珠菌病58例、结核46例、感染性腹泻31例、细菌性肺炎19例、肺孢子菌肺炎16例、颅内感染10例。经治疗后,机会性感染治愈或好转出院83例,死亡9例(包括中枢神经系统病变4例,结核2例,肺孢子菌肺炎1例,败血症1例,全身衰竭1例),未愈8例。结论艾滋病并发呼吸系统和消化系统感染多见,大部分治疗效果好,但结核和颅内感染预后较差。     

Spectrum of opportunistic infections in subjects infected with HIV at Libreville, Gabon

This retrospective study (1992-1996) was carried out in the Internal Medicine Department of the Jeanne Ebori Foundation at Libreville. We analyzed 351 files with the aim of counting the numbers of cases of various opportunistic infections and estimating the frequencies of these infections. The prevalence of seropositivity for HIV was 27.7% in the hospital population. Young adults from modest socioeconomic backgrounds were found to consult at stage IV of the infection. Oropharyngeal candidiasis (37%), zona (18.5%), salmonellosis (18.2%) and tuberculosis (14.5%) were the most frequently diagnosed opportunistic infections. Intestinal parasitoses, cryptococcosis, radiculomeningitis, cerebral toxoplasmosis and visceral fungal infections were diagnosed less frequently. The prevalence of Kaposi's sarcoma was 6.3%. Most of the opportunistic infections encountered were treatable but the mortality rate was high (11.7%) due to late diagnosis, the lack of availability of drugs and the poor economic conditions of the population.     

Factors associated with the presence of tuberculosis in patients with acquired immunodeficiency syndrome in Cuba]

OBJECTIVES: To determine the factors associated with the development of tuberculosis in patients with acquired immunodeficiency syndrome (AIDS) and to identify the most frequent symptoms and signs of tuberculosis in this group of patients. METHODS: This retrospective observational case-control study was carried out with 143 patients diagnosed with AIDS who were discharged from the Pedro Kourí Institute of Tropical Medicine, which is in the city of Havana, Cuba, between January 1997 and March 2001. The cases were 72 patients with AIDS and some clinical form of tuberculosis, while the control group was made up of the first 71 AIDS patients without tuberculosis who were discharged. The following variables were evaluated: AIDS stage before the study, serious opportunistic infections suffered before the diagnosis of tuberculosis (pulmonary pneumocystosis, cerebral toxoplasmosis, systemic candidiasis, isosporiasis, and recurrent pneumonia), concentration of CD4+ T lymphocytes, and clinical symptoms and signs of tuberculosis. The primary data were taken from the clinical files of the patients. We calculated the frequency of the nominal qualitative variables and the crude odd ratios (ORs) and their 95% confidence intervals (CIs). The statistical association among the variables was determined with the chi-square test with Yates correction. The individual effect of each variable was assessed through multivariate logistic regression analysis. The level of statistical significance was 0.05. RESULTS: Tuberculosis in this group of patients showed a statistically significant association with: being ill with AIDS before the study (OR = 3.57; 95% CI: 1.78 to 7.17); a history of pulmonary pneumocystosis (OR = 4.73; 95% CI: 1.51 to 15.76), cerebral toxoplasmosis (OR = 6.22; 95% CI: 1.21 to 42.99), or systemic candidiasis (OR = 11.29; 95% CI: 1.40 to 246.5); and having CD4+ T lymphocyte concentrations lower than 200 cells/mm(3). However, the logistic regression showed a significant association only with the history of systemic candidiasis (OR = 10.47; 95% CI: 1.06 to 103.5; P = 0.0446). The symptoms associated with the clinical diagnosis of tuberculosis were hemoptysis (OR = 7.54; 95% CI: 1.88 to 170.34), fever of unknown origin (OR = 13.38; 95% CI: 5.55 to 32.96), night sweats (OR = 21.95; 95% CI: 4.66 to 142.43), and weight loss (OR = 3.52; 95% CI: 1.65 to 7.55). The associated signs were regional lymphadenopathies (OR = 10.00; 95% CI: 1.22 to 220.3), hepatomegaly (OR = 5.44; 95% CI: 1.76 to 17.95), and splenomegaly (OR = 5.08; 95% CI: 1.63 to 16.83). CONCLUSIONS: The symptoms and signs seen most frequently in the patients with AIDS and tuberculosis are the characteristics of tuberculosis in patients without AIDS. In patients with AIDS, tuberculosis can be associated with other diseases whose symptoms are similar to those of tuberculosis. Nevertheless, these results indicate that the traditional symptoms of tuberculosis can help diagnose tuberculosis in this group of patients.     

新疆地区40例艾滋病患者临床特点分析

目的分析某院收治的40例艾滋病患者的临床特征。方法回顾性研究2003年1月-2004年8月以发热或腹泻、消瘦为主诉收治诊断为人免疫缺陷病毒（HIV）感染患者的临床资料。结果40例患者的临床分期均已到艾滋病期，CD4+T淋巴细胞计数为（156.54±131.26）/μL（正常参考值为800～1 200/μL）。发热、咳嗽咳痰、消瘦、腹痛腹泻以及颈部淋巴结大为主要临床表现，部分患者有卡波西肉瘤；机会性感染及合并症以肝炎病毒感染（30例，75.00%）、肺结核（15例，37.50%）多见。HIV感染方式以静脉吸毒为主（32例，80.00%），其次为性途径感染（4例，10.00%）。距可能暴露（静脉吸毒、性接触、输血）HIV时间2～12年，平均（7.31±1.30）年。结论艾滋病期患者临床表现多样化，静脉吸毒是主要的感染传播方式。需采取多种措施预防控制HIV的传播，对患者加强抗病毒治疗与监测、随访，及时控制机会性感染以及病毒复制。     

Regional differences in presentation of AIDS in Europe

Data were collected on 6578 patients diagnosed with AIDS at 52 clinical centres in 17 European countries during an 1-year period from 1979 to 1989. The centres were divided into four regions, North, Central, Southeast, and Southwest. Differences in the incidence of most AIDS-defining opportunistic infections and malignancies were found. After adjusting for known possible confounders, statistically significant differences between regions remained. Pneumocystis carinii pneumonia (PCP) was more common in Northern Europe, Kaposi's sarcoma and toxoplasmosis in Central Europe, cytomegalovirus retinitis in South-eastern Europe, and extrapulmonary tuberculosis in South-western Europe. These differences we attribute primarily to different degrees of exposure to the respective underlying pathogens. The prevalence of these and other micro-organisms will determine the clinical course of HIV infections in parts of Eastern Europe and elsewhere where the virus now is spreading.     

Epidemiological and clinical features of HIV-2 infection in Dakar

OBJECTIVE: The aim of this article was to describe the epidemiological and clinical aspects of HIV-2 infection in Dakar. DESIGN AND METHODS: This retrospective study was made on 217 HIV-2 infected patients hospitalized between 1986 and 2003; the epidemiological, clinical, and paraclinical data was collected and analyzed using the Epi-Info software version 6.04. RESULTS: The mean age was 40 years+/-9.6 and the male to female sex ratio was 1.33. The mode of transmission was primarily heterosexual. Some risk factors (travel abroad, heterosexual multi-partners, and unprotected sexual intercourse) were more frequently observed in men while others (blood transfusion, HIV positive partners) were noted among HIV-2 infected women. The most frequent symptoms were weight loss (88%), diarrhea (77%), fever (72.4%), asthenia (70.5%), chronic cough, and dermatosis (50.7%). The main opportunistic infections were oral candidiasis (61.8%), tuberculosis (26.3%), intestinal parasitosis (20.3%). The lethality rate was 33.2% and it was correlated with a low CD4 rate. Meningoencephalitis and bacterial infections were associated with a high lethality rate. CONCLUSIONS: The epidemiological and clinical aspects of HIV-2 infection were the same as in HIV-1 infected patients. However the lethality rate remained high among patients hospitalized with a low CD4 cell count. Early HIV testing and improving the diagnostic approach for opportunistic infections remains a high priority.     

690例HIV+/AIDS首诊病例的临床特征及与免疫状态和病毒载量相关性研究

目的以艾滋病病毒（HIV）感染的首诊病例分析临床特征与免疫状态和病毒载量的关系。方法横断面分析了690例HIV感染病例,采用SPSS13．0统计软件分析。结果690例HIV感染病例中男性是女性的2倍,平均年龄35.3岁;感染途径以性途径传播为主,其中因男男性行为和异性性行为而感染的分别是17．5％和16．7％;男男性行为感染者以来自北京地区且学历在大学以上者为主;夫妻间性传播感染占7.8％,双性性行为感染占11．6％。来自河南、安徽、山西、河北等地区的非法采供血／血浆和接受HIV污染的受血者,在发现感染原因中以医院的各种筛查为主,尤其是因皮肤病性病的筛查而发现占多数,发现时多数病例已有严重的免疫缺陷,其中37．3％的病例CD4^＋ T淋巴细胞〈50个／μl;此外,婚前和孕期检查、出入境检疫等都是重要的发现环节;首诊时临床的系统疾病发病率前五位依次是：皮肤病、肺炎、上呼吸道感染、肝炎、消化道念珠菌病;此时患者同时合并的病种增加;但当CD4^＋ T淋巴细胞〉251个/μl时,各种疾病的发病减少;病毒载量越高,CD4^＋ T淋巴细胞数越低,机会感染和并发症越多。结论首诊时HIV感染患者的免疫水平已经很低,病情已经接近艾滋病期。     

Infection with Pneumocystis carinii is prevalent in healthy Gambian children

Pneumocystis pneumonia is rarely identified in the many immunosuppressed individuals with acquired immune deficiency syndrome (AIDS) and malnutrition in Africa. To test whether infection with Pneumocystis carinii occurs in the continent we conducted a comparative serological study, measuring by enzyme-linked immunosorbent assay antibodies to the parasite in 150 healthy young individuals from both Britain and the Gambian savanna. The prevalence of significant titres of antibody to P. carinii steadily increased with age and included more than 70% of both populations by 8 years of age. Infection with P. carinii is, therefore, common in the Gambia. Thus opportunistic pneumocystis pneumonia may be an important but largely unrecognized disease in the continent, though its impact is probably diminished by the prevalence of fatal tuberculous infection, particularly in the AIDS population.     

Epidemiology of aids defining conditions in Greece

OBJECTIVE: To examine the secular trends of all AIDS opportunistic infections to occur first (OIs) in Greece, by year, by gender and by mode of transmission. METHODS: The study included all AIDS defining conditions reported among Greek residents diagnosed with AIDS from 1981 to June 2003 and notified to the Hellenic Centre of Infectious Diseases Control. The analysis of trends in AIDS defining conditions in Greece has been performed only for the period 1993--2003. RESULTS: From 1981 to the first six months of 2003, 2,394 AIDS cases, 2,361 adults and 33 children, have been reported. HIV wasting syndrome was the most frequent OI to occur first followed by PCP pneumonia and Kaposi sarcoma. The frequency at which OIs occurred first varied by sex. Kaposi sarcoma was more frequent in males while tuberculosis and oesophageal candidiasis were more frequent in females. The frequency at which OIs occurred first varied also by exposure mode. Kaposi sarcoma was more frequent among men who have sex with men but that was not the case for the remaining transmission categories. From 1993 to the first six months of 2003 a downward trend was noticed only for chronic simplex disease. Since the introduction of HAART, an increasing trend was noticed for CMV disease, recurrent pneumonia, oesophageal candidiasis, Burkitt and immunoblastic lymphoma. CONCLUSION: Further epidemiological studies are needed to assess the OIs trends in coming years in order to plan prevention strategies and future medical care needs.     

Uveitis in patients with HIV infection

We carried out a retrospective analysis of 581 patients with uveitis seen over an 11-year period, to determine the prevalence of HIV infection in these patients and to look for associated diseases and the possible causes of uveitis in HIV-infected patients. All patients underwent routine eye examination and most also underwent a general examination and complementary tests. The prevalence of HIV infection was 14.3% (89 patients). Anterior uveitis (62%) was the most frequent, followed by posterior uveitis (22%), panuveitis (12%) and intermediate uveitis (4%). Associated conditions or causes were identified in 88% of the HIV-infected patients, with herpes zoster ophthalmicus the most frequent (43 %), followed by tuberculosis (16%), CMV infection (12%) and toxoplasmosis (10%). Thus, uveitis in HIV-infected patients is frequently associated with opportunistic infections.     

Clinical and immunological profile of HIV infected patients in Cotonou, Benin

OBJECTIVES: This study had for aim to identify the clinical status and the level of immuno-deficiency of HIV-infected patients on their first visit. METHODS: One hundred and thirty-six HIV+ patients were prospectively evaluated from November 1, 2001 to May 31, 2002. RESULTS: One hundred and thirty-four were infected with HIV1 and two with HIV2. The mean age on the first consultation was 37 +/- 2 years. The m/w sex ratio was 0.9. 46.3% were stage C. The main clinical symptoms were: weight loss (88%), fever (80%), cough (71%), diarrhea (51%). BMI was normal in 70% and KI > or =80% in 57% of the cases but immuno-deficiency was severe with CD4 cells count <200 per mm3 in 69%. The main diseases were digestive candidiasis (53%), pneumonia (18%), tuberculosis (12%), non-determined pneumonia (29%), prurigo (20%), zona (16%), cryptosporidiosis (4%), cerebral toxoplasmosis (3%), and Kaposi's sarcoma (1%).