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Lancet Regional Health-Americas Pub Date : 2025-04-03 DOI:10.1016/j.lana.2025.101085

Alessandro C. Pasqualotto , Omar Sued , Nicole Reis , Larissa R. Silva , Renata B.A. Soares , Cassia S.M. Godoy , Marineide G. Melo , Nayla A. Hatem , Bruna Regis Razzolini , Andressa Noal , Tarsila Vieceli , Diego R. Falci , Freddy Perez

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引用次数: 0

摘要

背景机会性感染（OIs）是导致晚期艾滋病发病率和死亡率的重要原因。本研究评估了巴西常规 HIV 护理中结核病 (TB)、组织胞浆菌病和隐球菌病的护理点 (POC) 诊断的有效性。方法在五家医院开展了一项前瞻性多中心队列研究，招募了 CD4+ T 细胞计数为 <200 cells/mm3 或有 OI 症状的 HIV 感染者（PLHIV）（无论 CD4 细胞计数为多少）、HIV 病毒免疫患者、开始接受治疗的患者以及失去随访（>3 个月）的病毒载量未被抑制的患者。POC检测包括VISITECT CD4晚期疾病、TB LAM Ag（雅培）、GeneXpert MTB/RIF（Cepheid）、组织胞浆抗原LFA（MiraVista）和CrAg LFA（IMMY）。对患者进行了 30 天和 90 天的随访。在 419 名艾滋病毒感染者中（55% 为男性，44% 为女性，1% 为变性人；平均年龄：42 岁，SD ± 11.1），46% 已确诊为 OIs：结核病（34%）、隐球菌病（12%）、组织胞浆菌病（10%）。结核病和组织胞浆菌病（44%）经常合并感染。隐球菌脑膜炎和严重组织胞浆菌病的确诊率分别为 5%和 6%。在接受检测的患者中，有 27% 的人肺结核 LAM 呈阳性，其中 74% 的人患有播散性肺结核。与历史数据相比，POC 检测提高了结核病（1.8 倍）、隐球菌病（2.8 倍）和组织胞浆菌病（2.8 倍）的检出率。30 天的存活率为 87%，90 天的存活率为 80%，隐球菌抗原血症与较高的死亡率有关。这些发现强调了将快速诊断纳入艾滋病项目的重要性，以及进一步研究长期结果的必要性。

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Impact of the introduction of a package of care involving early detection of opportunistic infections, a prospective multicenter cohort study of people living with HIV/AIDS in Brazil

Background

Opportunistic infections (OIs) significantly contribute to morbidity and mortality in advanced HIV disease. This study evaluates the efficacy of point-of-care (POC) diagnostics for tuberculosis (TB), histoplasmosis, and cryptococcosis in routine HIV care in Brazil.

Methods

A prospective multicenter cohort study was conducted across five hospitals enrolling people living with HIV (PLHIV) with CD4+ T-cell count <200 cells/mm³ or OI symptoms, regardless of CD4 count, HIV-naïve patients, those initiating treatment, and individuals with unsuppressed viral load lost to follow-up (>3 months). POC tests included VISITECT CD4 Advanced Disease, TB LAM Ag (Abbott), GeneXpert MTB/RIF (Cepheid), Histoplasma antigen LFA (MiraVista), and CrAg LFA (IMMY). Patients were followed at 30 and 90 days. Retrospective data for six months pre-study was collected for comparison.

Findings

Among 419 PLHIV (55% cisgender men, 44% cisgender women, 1% transgender; mean age: 42 years, SD ± 11.1), 46% had confirmed OIs: TB (34%), cryptococcosis (12%), histoplasmosis (10%). Co-infections were frequent, with TB and histoplasmosis (44%). Cryptococcal meningitis and severe histoplasmosis were diagnosed in 5% and 6%, respectively. TB LAM was positive in 27% of tested patients, with 74% having disseminated TB. POC testing increased detection rates for TB, (1.8-fold) cryptococcosis (2.8-fold), and histoplasmosis (2.8-fold) compared to historical data. Survival rates were 87% at 30 days and 80% at 90 days, with cryptococcal antigenemia associated with higher mortality.

Interpretation

POC testing improved OI diagnosis, aligning with WHO guidelines. These findings highlight the importance of integrating rapid diagnostics into HIV programs and the need for further research on long-term outcomes.

Funding

Pan American Health Organization.

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来源期刊

Lancet Regional Health-Americas Multiple-

CiteScore

8.00

自引率

0.00%

发文量

期刊介绍： The Lancet Regional Health – Americas, an open-access journal, contributes to The Lancet's global initiative by focusing on health-care quality and access in the Americas. It aims to advance clinical practice and health policy in the region, promoting better health outcomes. The journal publishes high-quality original research advocating change or shedding light on clinical practice and health policy. It welcomes submissions on various regional health topics, including infectious diseases, non-communicable diseases, child and adolescent health, maternal and reproductive health, emergency care, health policy, and health equity.