Critical Importance of Long-Term Adherence to Care in HIV Infected Patients in the cART Era: New Insights from Pneumocystis jirovecii Pneumonia Cases over 2004-2011 in the FHDH-ANRS CO4 Cohort

被引：4

作者：

Denis, Blandine ^{[1
,2
]}

Guiguet, Marguerite ^{[1
,2
]}

de Castro, Nathalie ^{[3
,4
]}

Mechai, Frederic ^{[5
]}

Revest, Matthieu ^{[6
]}

Mahamat, Aba ^{[7
,8
]}

Gregoire, Giovanna Melica ^{[3
,4
]}

Lortholary, Olivier ^{[9
,10
,11
,12
]}

Costagliola, Dominique ^{[1
,2
]}

机构：

[1] INSERM, UMRS 1136, Paris, France

[2] Univ Paris 06, UMRS 1136, Paris, France

[3] CHU St Louis, AP HP, Serv Malad Infect & Trop, Paris, France

[4] Univ Paris Diderot, Paris, France

[5] CHU Avicenne, AP HP, Serv Malad Infect & Trop, Bobigny, France

[6] CHU Rennes, Serv Malad Infect & Trop, Rennes, France

[7] CHU Cayenne, Serv Malad Infect & Trop, Cayenne, France

[8] Univ Antilles Guyane, EA 3595, Cayenne, France

[9] CHU Necker Enfants Malad, AP HP, Ctr Infectiol Necker Pasteur, Paris, France

[10] Univ Paris 05, Inst Imagine, Paris, France

[11] Inst Pasteur, Ctr Natl Reference Mycoses Invas & Antifong, Paris, France

[12] CNRS, URA 3012, Paris, France

来源：

PLOS ONE | 2014年 / 9卷 / 04期

关键词：

ACTIVE ANTIRETROVIRAL THERAPY; T-CELL COUNT; UNITED-STATES; MORTALITY; AIDS; EPIDEMIOLOGY; RECOVERY;

D O I：

10.1371/journal.pone.0094183

中图分类号：

O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];

学科分类号：

07 ; 0710 ; 09 ;

摘要：

Objective: To describe characteristics and outcomes of HIV-infected patients with Pneumocystis jirovecii pneumonia (PCP) over 2004-2011 in France, in particular in those previously enrolled (PE) in the French Hospital Database on HIV (FHDH). Methods: PE patients with an incident PCP were compared with patients with an inaugural PCP revealing HIV infection (reference). Adequate adherence to care was defined as a CD4 measurement at least every 6 months. Immune reconstitution (CD4 >= 200/mm(3)) and risk of death were studied using Kaplan-Meier estimates and multivariable Cox proportional hazards models. Results: In a context of a decreasing incidence of PCP, 1259 HIV-infected patients had a PCP diagnosis, and 593 (47%) were PE patients of whom 161 (27%) have had a prior history of AIDS-defining clinical illness (prior ADI). Median time since enrolment was 8 years for PE patients; 74% had received cART. Median proportion of time with adequate adherence to care was 85% (IQR, 66-96) for all FHDH enrollees, but only 45% (IQR, 1-81) for PE patients during the 2 years before PCP. Median CD4 cell count (38/mm(3)) and HIV viral load (5.2 log10 copies/ml) at PCP diagnosis did not differ between PE patients and the reference group. Three year mortality rate of 25% was observed for PE prior ADI group, higher than in PE non-prior ADI group (8%) and the reference group (9%) (p<0.0001). In the PE prior ADI group, poor prognosis remained even after adjustment for virological control and immune reconstitution (HR, 2.4 [95% CI, 1.5-3.7]). Conclusion: Almost 50% of PCP diagnoses in HIV-infected patients occurred presently in patients already in care, mainly with a previous cART prescription but with waning adherence to care. Having repeated ADI is contributing to the risk of death beyond its impact on immune reconstitution and viral suppression: special efforts must be undertaken to maintain those patients in care.

引用

页数：8