TTV和HCMV而非EBV对住院hiv阳性患者预后的临床预后价值

IF 3.5 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Biosafety and Health Pub Date : 2025-06-01 DOI:10.1016/j.bsheal.2025.05.006

Qinghong Fan , Guofang Tang , Mengling Jiang , Yujuan Xu , Nenglang Pan , Zhiwei Liang , Chuyu Zhang , Pinghong Li , Feilong Xu , Zhimin Chen , Bo Liu , Lingzhen Chen , Youxia Li , Chuo Li , Fengyu Hu , Feng Li

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Additionally, a multiplex polymerase chain reaction (PCR) detection kit to identify ten commonly known respiratory pathogens was applied to the LRT samples. Of 126 HIV-positive patients, 111 (88.1 %) were coinfected with at least one known virus. Epstein-Barr virus (EBV) (71/111, 64.0 %), human cytomegalovirus (HCMV) (64/111, 57.7 %), and torque teno virus (TTV) (63/111, 56.8 %) were the three most prevalent coinfected viruses. Fungal coinfections (58/126, 46.0 %) and bacterial coinfections (47/126, 37.3 %) were less frequent than viral coinfections. Higher viral loads of coinfection were associated with fungal coinfections (odds ratio [OR] = 2.573, 95 % confidence interval [CI]: 1.150–5.757, <em>P</em> = 0.0214) and lower CD4<sup>+</sup>/CD8<sup>+</sup> T cell ratios (OR = 0.048, 95 % CI: 0.005–0.429, <em>P</em> = 0.0067). Importantly, patients with higher loads of HCMV and TTV, but not EBV, exhibited worse clinical outcomes. 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引用次数: 0

摘要

由病毒、细菌、真菌和寄生虫引起的机会性感染，在住院的人类免疫缺陷病毒（HIV）阳性患者中经常被报道，但它们对疾病严重程度的有害贡献仍有待探讨。在这项研究中，我们检查了126例疑似呼吸道、血液或神经系统感染的hiv阳性患者的合并感染情况。入院前7天内采集的下呼吸道（LRT）样本、脑脊液和血液样本进行了新一代宏基因组测序（mNGS）。此外，对LRT样本应用多重聚合酶链反应（PCR）检测试剂盒鉴定10种常见的呼吸道病原体。在126例hiv阳性患者中，111例（88.1%）至少同时感染了一种已知病毒。Epstein-Barr病毒（EBV）（71/111, 64.0%）、人巨细胞病毒（HCMV）（64/111, 57.7%）和torque teno病毒（TTV）（63/111, 56.8%）是最常见的3种共感染病毒。真菌共感染（58/126,46.0%）和细菌共感染（47/126,37.3%）发生率低于病毒共感染。合并感染较高的病毒载量与真菌合并感染相关（比值比[OR] = 2.573, 95%可信区间[CI]: 1.150 ~ 5.757, P = 0.0214）， CD4+/CD8+ T细胞比值较低（OR = 0.048, 95% CI: 0.005 ~ 0.429, P = 0.0067）。重要的是，HCMV和TTV载量较高的患者表现出更差的临床结果，而EBV没有。具体来说，HCMV患者的每百万读数（RPM） >；0和TTV RPM >；5例预后不良及入住重症监护病房（ICU）的风险明显增高。相反，在这种情况下，EBV RPM与临床结果没有关联。总之，HCMV和TTV可能是与hiv阳性患者预后较差相关的预后生物标志物。检测HCMV和TTV可以预测临床结果，改善患者管理策略。

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Clinical prognostic value of TTV and HCMV but not EBV for outcomes in hospitalized HIV-positive patients

Opportunistic infections caused by viruses, bacteria, fungi, and parasites, are commonly reported in hospitalized human immunodeficiency virus (HIV)-positive patients, but their detrimental contribution to disease severity remains under explored. In this study, we examined the coinfection profiles of 126 HIV-positive patients with suspected respiratory, bloodstream, or neurological infections. Lower respiratory tract (LRT) samples, cerebrospinal fluid, and blood samples collected within the first seven days of admission were subjected to metagenomic next-generation sequencing (mNGS). Additionally, a multiplex polymerase chain reaction (PCR) detection kit to identify ten commonly known respiratory pathogens was applied to the LRT samples. Of 126 HIV-positive patients, 111 (88.1 %) were coinfected with at least one known virus. Epstein-Barr virus (EBV) (71/111, 64.0 %), human cytomegalovirus (HCMV) (64/111, 57.7 %), and torque teno virus (TTV) (63/111, 56.8 %) were the three most prevalent coinfected viruses. Fungal coinfections (58/126, 46.0 %) and bacterial coinfections (47/126, 37.3 %) were less frequent than viral coinfections. Higher viral loads of coinfection were associated with fungal coinfections (odds ratio [OR] = 2.573, 95 % confidence interval [CI]: 1.150–5.757, P = 0.0214) and lower CD4⁺/CD8⁺ T cell ratios (OR = 0.048, 95 % CI: 0.005–0.429, P = 0.0067). Importantly, patients with higher loads of HCMV and TTV, but not EBV, exhibited worse clinical outcomes. Specifically, patients with HCMV reads per million (RPM) > 0 and TTV RPM > 5 exhibited significantly higher risks of poor prognosis and intensive care unit (ICU) admission. In contrast, EBV RPM showed no association with clinical outcomes in this context. In conclusion, HCMV and TTV may serve as prognostic biomarkers linked to poorer outcomes in HIV-positive patients. Detection of HCMV and TTV could predict clinical outcomes and improve patient management strategies.

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