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Pneumocistose em doentes com infecção por VIH : casuística do Serviço de Doenças Infecciosas do Hospital de Santa Maria no período 2002 – 2013
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Introdução – A pneumonia por Pneumocystis jirovecii (pneumocistose ou PPc) é das patologias oportunísticas mais comuns em infectados por Vírus da Imunodeficiência Humana (VIH). Em Portugal é, actualmente, a infecção definidora de sida mais reportada. Objectivos – Analisar as características da população com PPc em infectados por VIH. Métodos – Estudo restrospectivo, observacional, não controlado, que incluiu os doentes internados no Serviço de Doenças Infecciosas (SDI) do Hospital de Santa Maria (HSM) – Centro Hospitalar Lisboa Norte (CHLN), EPE, entre 1 de Janeiro de 2002 e 31 de Dezembro de 2013, com o diagnóstico de PPc em infectados por VIH. Assim, foram analisadas as características demográficas dos doentes, a informação sobre a infecção por VIH, a apresentação clínica e os dados do internamento e, finalmente, o estado imunitário, a carga vírica e a terapêutica instituída. Posteriormente, estes dados foram comparados consoante o conhecimento da infecção por VIH, meio de diagnóstico e destino após a alta. Variáveis analisadas por teste Qui-Quadrado e Mann-Whitney. Resultados – Foram incluídos 107 doentes, 81,3% (n=87) eram do sexo masculino, com média de idade de 42, 2 ± 11,0 anos, contagem de linfócitos TCD4+ de 51,93 ± 62,19 células/mm3 e carga vírica 5,45 ± 0,72 log. P. jirovecii foi identificado em 55,1% (n=59) dos casos, a mortalidade foi de 13,1% (n=14) e 8,4% (n=9) dos doentes foram reinternados. A terapêutica de 1ª linha mais utilizada foi TMP-SMX em 91,6% (n=98), associado a corticóides em 75,7% (n=81) e com toxicidade em 23,4% (n=25) dos doentes. Em 73,8% (n=79) dos doentes foi dado início à profilaxia secundária. Conclusão – A população com PPc, neste grupo de doentes infectados por VIH, apresenta características muito semelhantes às descritas na literatura.
Background – Pneumocystis jirovecii pneumonia (pneumocystosis or PcP) remains one of the most common opportunistic illnesses in patients infected with the human immunodeficiency virus (HIV). It is currently the most reported AIDS-defining infection in Portugal. Objectives – To analyze the characteristics of an HIV and P. jirovecii coinfected population. Methods – A retrospective, observational, non-controlled study was conducted. The patients admitted to the Department of Infectious Diseases at Santa Maria’s Hospital, in Lisbon, between the 1st of January 2002 and the 31st of December 2013, that presented the simultaneous diagnosis of HIV infection and PcP were included. Demographic and HIV infection data, PcP clinical presentation and progress during hospitalization, and treatment options were studied. Patients were further divided into groups based on the previous knowledge of the HIV infection, diagnostic method and clinical outcome. The variables were analyzed using the Chi-Squared and Mann-Whitney tests. Results – Data from 107 patients was analyzed; 81,3% (n=87) were male, the mean patient age was 42,2 ± 11,0 years, the mean TCD4+ cell count was 51,93 ± 62,19 cells/mm3 and the mean viral load was 5,45 ± 0,72 log. P. jirovecii was identified in 55,1% (n=59), the in-hospital mortality was 13,1% (n=14) and 8,4% (n=9) developed a second PcP episode. The inicial drug of choice was TMP-SMX (91,6%; n=98), and corticosteroid adjuvant therapy was added in 75,7% (n=81). Adverse reactions were reported in 23,4% (n=25), and 73,8% (n=79) started secondary chemoprophylaxis. Conclusions – This population of HIV and PcP coinfected patients shows similarities with the data from previous studies.
Background – Pneumocystis jirovecii pneumonia (pneumocystosis or PcP) remains one of the most common opportunistic illnesses in patients infected with the human immunodeficiency virus (HIV). It is currently the most reported AIDS-defining infection in Portugal. Objectives – To analyze the characteristics of an HIV and P. jirovecii coinfected population. Methods – A retrospective, observational, non-controlled study was conducted. The patients admitted to the Department of Infectious Diseases at Santa Maria’s Hospital, in Lisbon, between the 1st of January 2002 and the 31st of December 2013, that presented the simultaneous diagnosis of HIV infection and PcP were included. Demographic and HIV infection data, PcP clinical presentation and progress during hospitalization, and treatment options were studied. Patients were further divided into groups based on the previous knowledge of the HIV infection, diagnostic method and clinical outcome. The variables were analyzed using the Chi-Squared and Mann-Whitney tests. Results – Data from 107 patients was analyzed; 81,3% (n=87) were male, the mean patient age was 42,2 ± 11,0 years, the mean TCD4+ cell count was 51,93 ± 62,19 cells/mm3 and the mean viral load was 5,45 ± 0,72 log. P. jirovecii was identified in 55,1% (n=59), the in-hospital mortality was 13,1% (n=14) and 8,4% (n=9) developed a second PcP episode. The inicial drug of choice was TMP-SMX (91,6%; n=98), and corticosteroid adjuvant therapy was added in 75,7% (n=81). Adverse reactions were reported in 23,4% (n=25), and 73,8% (n=79) started secondary chemoprophylaxis. Conclusions – This population of HIV and PcP coinfected patients shows similarities with the data from previous studies.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2015
Palavras-chave
Pneumocystis jirovecii Pneumocistose Pneumonia por Pneumocystis PPc VIH/sida Doenças transmissíveis