Etiology of pulmonary complications of human immunodeficiency virus-1-infected patients in Taiwan in the era of combination antiretroviral therapy: A prospective observational study
Journal
Journal of Microbiology, Immunology and Infection
Journal Volume
46
Journal Issue
6
Pages
433-440
Date Issued
2013
Author(s)
Lee K.-Y.
Ji D.-D.
Lee C.-M.
Tsai M.-S.
Tsai S.-Y.
Tseng Y.-T.
Lee Y.-C.
Abstract
Objectives: We aimed to investigate the etiology of pulmonary complications of human immunodeficiency virus-(HIV)-1-infected patients in Taiwan in the era of combination antiretroviral therapy (cART). Methods: From July 2009 to March 2012, a prospective observational study was conducted to identify the etiology of pulmonary complications in HIV-1-infected patients who sought HIV care at a university hospital in Taiwan. A stepwise diagnostic approach was adopted, which included radiography, serology, microbiology, bronchoscopy or video-assisted thoracoscopicsurgery, and polymerase chain reaction assays for cytomegalovirus and Pneumocystis jirovecii. Results: During the study period, a total of 203 episodes of pulmonary complications that occurred in 190 patients with a mean CD4 count of 123×106cells/L were analyzed. Thirty-eight episodes (18.7%) occurred in patients with a CD4 count >200×106cells/L, 71 (35.0%) between 50 and 200×106cells/L, and 94 (46.3%) <50×106cells/L. Pneumocystis pneumonia accounted for more than half of the complications in patients with a CD4 count <200×106cells/L. In patients with a CD4 count >200×106cells/L, the etiology of pulmonary complications was diverse, with bacterial infections (47.4%) being the most common, followed by tuberculosis (15.8%) and lung edema (13.2%). Pneumocystosis and cytomegalovirus pneumonitis were seen mostly or exclusively in patients with a CD4 count <200×106cells/L and were the leading causes of interstitial pneumonitis. On the other hand, empyema, legionellosis, and lung edema were more commonly seen in patients with a CD4 count >200×106cells/L. Conclusions: The etiology of pulmonary complications in HIV-1-infected patients was diverse and varied with the categories of CD4 counts. Pneumocystosis remained the leading cause of pulmonary complications in patients with lower CD4 counts in Taiwan in the cART era. ? 2012 .
SDGs
Other Subjects
foscarnet; ganciclovir; adult; article; aspergillosis; asthma; bacterial pneumonia; bronchiectasis; bronchoscopy; CD4 lymphocyte count; chronic obstructive lung disease; controlled study; cryptococcosis; Cytomegalovirus; empyema; female; highly active antiretroviral therapy; human; Human immunodeficiency virus 1; Human immunodeficiency virus infected patient; Human immunodeficiency virus infection; interstitial pneumonia; legionnaire disease; lung edema; lung embolism; lung infection; major clinical study; male; nocardiosis; observational study; penicilliosis; pneumococcal infection; Pneumocystis jiroveci; Pneumocystis pneumonia; pneumocystosis; pneumonia; prospective study; pulmonary hypertension; randomized controlled trial; respiratory failure; serology; Taiwan; thorax radiography; tuberculosis; university hospital; video assisted thoracoscopic surgery; Bacterial pneumonia; Cytomegalovirus pneumonitis; Interstitial pneumonitis; Pneumocystis jirovecii pneumonia; Pulmonary complication; Tuberculosis; Adult; Anti-Retroviral Agents; Antiretroviral Therapy, Highly Active; CD4 Lymphocyte Count; Female; HIV Infections; HIV-1; Hospitals, University; Humans; Lung Diseases, Fungal; Male; Middle Aged; Pneumonia, Bacterial; Prospective Studies; Pulmonary Edema; Taiwan
Type
journal article