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Los predictores para el fracaso de Pneumocystis carinii en la profilaxis de la neumonía. Estudio de cohorte de SIDA

A J Saah¹, D R Hoover, Y Peng

¹Johns Hopkins University, School of Public Health, Baltimore, Md., 21205, USA.

|April 19, 1995

Resumen

La linfocitopenia profunda del T-helper es el principal predictor del fracaso de la profilaxis de la neumonía por Pneumocystis (PCP) en pacientes con VIH-1. Se necesitan mejores métodos de profilaxis para los recuentos de T-helper por debajo de 0.100 x 10 ((9) / L.

Área de la Ciencia:

Enfermedades infecciosas Enfermedades infecciosas.
Inmunología Inmunología.
Salud Pública La salud pública.

Sus antecedentes:

La neumonía por Pneumocystis (PCP) sigue siendo una infección oportunista significativa en personas con el virus de la inmunodeficiencia humana tipo 1 (VIH-1).
La profilaxis es crucial para prevenir la PCP, pero los factores que influyen en su fracaso requieren más investigación.

Objetivo del estudio:

Identificar los factores clínicos y epidemiológicos asociados con el fracaso de la profilaxis PCP en individuos infectados por el VIH-1 que reciben profilaxis primaria o secundaria.
Informar el desarrollo de estrategias preventivas más efectivas.

Principales métodos:

Estudio longitudinal de cohorte de 476 participantes infectados por el VIH-1 en el Estudio Multicéntrico de Cohorte del SIDA.
Análisis de los regímenes de profilaxis que incluyen trimetoprim-sulfametoxazol (TMP-SMX), dapsona y pentamidina en aerosol.
Análisis dependiente del tiempo de los recuentos de linfocitos T auxiliares y otros factores clínicos.

Principales resultados:

El 20% de los participantes desarrolló PCP a pesar de la profilaxis.
La linfocitopenia profunda del T-helper (cuentas < 0,075 x 10 ((9) / L) fue el principal predictor del fracaso de la profilaxis.
La fiebre también predijo la PCP posterior, mientras que TMP-SMX mostró un efecto protector.

Conclusiones:

Los regímenes actuales de profilaxis de PCP son insuficientes para las personas con inmunosupresión severa (cuentas de T-helper < 0.100 x 10 10 9 9 / L).
Existe una necesidad crítica de desarrollar regímenes de profilaxis inherentemente más efectivos para prevenir la PCP en esta población de alto riesgo.

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