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HIV感染者机会性感染的一级预防

Author
John G Bartlett, MD
Section Editor
Martin S Hirsch, MD
Deputy Editor
Jennifer Mitty, MD, MPH

引言

与人类免疫缺陷病毒(human immunodeficiency virus, HIV)相关的免疫抑制能够显著增加发生细菌、病毒、真菌和原虫导致的机会性感染(opportunistic infections, OI)的风险。这些OI是导致HIV感染者出现并发症和死亡的主要原因。

如今，人类在预防OI方面已取得重大进展。这些策略涉及预防性抗生素、免疫接种和公共卫生措施。预防感染的成本效益各不相同，较低者如卡氏肺孢子菌肺炎(pneumocystis carinii pneumonia, PCP)，每质量调整生命年花费$16,000，较高者如巨细胞病毒感染，其花费超过$300,000[1]。

下列推荐在很大程度上反映了2009年美国国家卫生研究院(National Institutes of Health, NIH)/美国疾病预防控制中心(Center for Disease Control and Prevention, CDC)/美国传染病学会(Infectious Diseases Society of America, IDSA)关于感染HIV的成人和青少年的机会性感染的治疗和预防指南[2]。2009年的指南强调了抗逆转录病毒治疗(antiretroviral therapy, ART)在重建免疫系统以减少OI风险中的首要地位[2]。同时，2009年指南亦新增了数种新的感染类型，包括乙型肝炎和疟疾。对这些疾病的预防和治疗将在别处讨论。 (参见“HIV感染者中乙型肝炎的流行病学、临床表现和诊断”和“艾滋病病毒感染者慢性乙型肝炎的治疗”和“HIV and malaria”)

采用预防性抗生素对最常见的OI进行一级预防将总结在此。具体OI的临床表现和治疗以及二级预防措施也将在别处讨论(见相关专题)。

机会性感染的流行病学

强效ART的广泛应用已使OI的发病率明显降低[3]。一项队列研究纳入了2410例1995-1997年间在瑞士7家医疗中心随访的患者，所有OI的发生率从接受治疗前6个月的15.1例/100人年下降至开始治疗后最初3个月的7.7例/100人年，再之后6个月(即3-9个月时)的2.6例/100人年，以及接受治疗后9-15个月时的2.2例/100人年[3]。在美国一项纳入超过8500例HIV感染者的多中心研究中，OI的发生率从1995的140例/1000观察人年下降至2007年的不到20例/1000观察人年[4]。在资源有限的环境和地区中，也发现了相似的趋势。 (参见“Global epidemiology of HIV infection”)

                                                                  

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Literature review current through: 2017-06 . | This topic last updated: 2015-11-17.
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