Association between respiratory pathogens and severe clinical outcomes in people living with HIV-1 and pulmonary infections: A 180-day longitudinal cohort study

IF 4.7 3区医学 Q1 INFECTIOUS DISEASES

Journal of Infection and Public Health Pub Date : 2025-02-10 DOI:10.1016/j.jiph.2025.102694

Yue Wang , Jing Cao , Qi Liu , Jie Huang , Pan Zhang , Zhenlan Zhang , Boqi Li , Ying Liu , Biao Xiao , Xiaoyun Song , Erik De Clercq , Guangdi Li , Fang Zheng

{"title":"Association between respiratory pathogens and severe clinical outcomes in people living with HIV-1 and pulmonary infections: A 180-day longitudinal cohort study","authors":"Yue Wang , Jing Cao , Qi Liu , Jie Huang , Pan Zhang , Zhenlan Zhang , Boqi Li , Ying Liu , Biao Xiao , Xiaoyun Song , Erik De Clercq , Guangdi Li , Fang Zheng","doi":"10.1016/j.jiph.2025.102694","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Many respiratory pathogens have been identified in people living with HIV-1 and pulmonary infection, but their impact on clinical outcomes remains largely unclear.</div></div><div><h3>Methods</h3><div>Metagenomic sequencing and traditional laboratory diagnostics were applied to identify bacterial, viral, and fungal respiratory pathogens. Clinical outcomes were assessed by (i) mortality or ICU transfer during hospitalization, and (ii) 30-day re-hospitalization and 180-day mortality after hospital discharge.</div></div><div><h3>Results</h3><div>Microbiological analyses of bacterial, viral and fungal pathogens in 237 in-patients with HIV-1 and pulmonary infections revealed <em>Pneumocystis jirovecii</em> (58 %) as the most prevalent respiratory pathogen, followed by <em>Cytomegalovirus</em> (39 %), <em>Mycobacterium tuberculosi</em>s (22 %), <em>Talaromyces marneffei</em> (17 %), and <em>Epstein-Barr virus</em> (16 %). Fifty-six patients (24 %) were coinfected with bacterial, viral and fungal pathogens, referred to as bacterial+fungal+viral coinfections. Risk factors for bacterial+fungal+viral coinfections (RR=8.41, 95 %CI: 4.2–14.3), severe pneumonia (RR=13.6, 95 %CI: 8.14–19.3), and elevated C-reactive protein levels (RR=6.42, 95 %CI: 1.58–10.13) were significantly associated with mortality or ICU transfer during hospitalization. After hospital discharge, 38 patients (16 %) were rehospitalized within 30 days. Antiretroviral therapy reduced the risk of 30-day rehospitalization (HR=0.21, p = 0.01). During the 180-day follow-up, 13 patients (5.5 %) died. Survival analyses identified severe pneumonia and age ≥ 60 years as risk factors for 180-day mortality.</div></div><div><h3>Conclusions</h3><div>Multiple pulmonary coinfections are associated with severe outcomes in in-patients with HIV-1 infection. Effective management of both HIV-1 and pulmonary infections is crucial to reduce hospitalization rates and mortality risk.</div></div>","PeriodicalId":16087,"journal":{"name":"Journal of Infection and Public Health","volume":"18 4","pages":"Article 102694"},"PeriodicalIF":4.7000,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Infection and Public Health","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1876034125000437","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Many respiratory pathogens have been identified in people living with HIV-1 and pulmonary infection, but their impact on clinical outcomes remains largely unclear.

Methods

Metagenomic sequencing and traditional laboratory diagnostics were applied to identify bacterial, viral, and fungal respiratory pathogens. Clinical outcomes were assessed by (i) mortality or ICU transfer during hospitalization, and (ii) 30-day re-hospitalization and 180-day mortality after hospital discharge.

Results

Microbiological analyses of bacterial, viral and fungal pathogens in 237 in-patients with HIV-1 and pulmonary infections revealed Pneumocystis jirovecii (58 %) as the most prevalent respiratory pathogen, followed by Cytomegalovirus (39 %), Mycobacterium tuberculosis (22 %), Talaromyces marneffei (17 %), and Epstein-Barr virus (16 %). Fifty-six patients (24 %) were coinfected with bacterial, viral and fungal pathogens, referred to as bacterial+fungal+viral coinfections. Risk factors for bacterial+fungal+viral coinfections (RR=8.41, 95 %CI: 4.2–14.3), severe pneumonia (RR=13.6, 95 %CI: 8.14–19.3), and elevated C-reactive protein levels (RR=6.42, 95 %CI: 1.58–10.13) were significantly associated with mortality or ICU transfer during hospitalization. After hospital discharge, 38 patients (16 %) were rehospitalized within 30 days. Antiretroviral therapy reduced the risk of 30-day rehospitalization (HR=0.21, p = 0.01). During the 180-day follow-up, 13 patients (5.5 %) died. Survival analyses identified severe pneumonia and age ≥ 60 years as risk factors for 180-day mortality.

Conclusions

Multiple pulmonary coinfections are associated with severe outcomes in in-patients with HIV-1 infection. Effective management of both HIV-1 and pulmonary infections is crucial to reduce hospitalization rates and mortality risk.

查看原文本刊更多论文

背景在HIV-1感染者和肺部感染者中发现了许多呼吸道病原体，但它们对临床结果的影响在很大程度上仍不清楚。方法应用组基因组测序和传统的实验室诊断方法确定细菌、病毒和真菌呼吸道病原体。临床结果通过以下两个方面进行评估：(i) 住院期间的死亡率或转入 ICU；(ii) 出院后 30 天的再次住院率和 180 天的死亡率。结果对 237 名患有 HIV-1 和肺部感染的住院患者进行的细菌、病毒和真菌病原体微生物学分析显示，肺孢子虫（58%）是最常见的呼吸道病原体，其次是巨细胞病毒（39%）、结核分枝杆菌（22%）、马涅菲他拉酵母菌（17%）和 Epstein-Barr 病毒（16%）。56名患者（24%）同时感染了细菌、病毒和真菌病原体，称为细菌+真菌+病毒合并感染。细菌+真菌+病毒合并感染（RR=8.41，95 %CI：4.2-14.3）、重症肺炎（RR=13.6，95 %CI：8.14-19.3）和 C 反应蛋白水平升高（RR=6.42，95 %CI：1.58-10.13）等危险因素与住院期间的死亡率或转入 ICU 有显著相关性。出院后，38 名患者（16%）在 30 天内再次住院。抗逆转录病毒治疗降低了 30 天内再次住院的风险（HR=0.21，P = 0.01）。在 180 天的随访中，13 名患者（5.5%）死亡。生存分析表明，重症肺炎和年龄≥60 岁是导致 180 天死亡的风险因素。有效控制 HIV-1 和肺部感染对降低住院率和死亡风险至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of Infection and Public Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH -INFECTIOUS DISEASES

CiteScore

13.10

自引率

1.50%

发文量

203

审稿时长

96 days

期刊介绍： The Journal of Infection and Public Health, first official journal of the Saudi Arabian Ministry of National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences and the Saudi Association for Public Health, aims to be the foremost scientific, peer-reviewed journal encompassing infection prevention and control, microbiology, infectious diseases, public health and the application of healthcare epidemiology to the evaluation of health outcomes. The point of view of the journal is that infection and public health are closely intertwined and that advances in one area will have positive consequences on the other. The journal will be useful to all health professionals who are partners in the management of patients with communicable diseases, keeping them up to date. The journal is proud to have an international and diverse editorial board that will assist and facilitate the publication of articles that reflect a global view on infection control and public health, as well as emphasizing our focus on supporting the needs of public health practitioners. It is our aim to improve healthcare by reducing risk of infection and related adverse outcomes by critical review, selection, and dissemination of new and relevant information in the field of infection control, public health and infectious diseases in all healthcare settings and the community.