Characteristics of respiratory pathogens and immunological features of 176 patients with human immunodeficiency virus and pulmonary infection

doi:10.3877/cma.j.issn.1674-1358.2024.03.003

Abstract

Abstract:

Objective

To investigate the characteristics of respiratory pathogens, immunological features and related risk factors of patients with human immunodeficiency virus (HIV) and pulmonary infection.

Methods

The bronchoalveolar lavage fluid and clinical data from 176 HIV-infected patients complicated with respiratory symptoms who were admitted to Beijing Ditan Hospital, Capital Medical University from January 2018 to December 2020 were collected, retrospectively. Pathogen were detected with multiplex real-time PCR, all cases were divided into detected group (118 cases) and undetected group (58 cases) based on the presence of pathogens. The single detection rate and complicated detection rate of pathogens were analyzed, and clinical and immunological indicators of the two groups were compared. Multivariate Logistic regression analysis was used to explore the risk factors for HIV combined with pulmonary infection.

Results

Total of 118 (67.0%) patients with HIV complicated with pulmonary infection were found to have one or more respiratory pathogens. The most commonly detected pathogen was Pneumocystis jirovecii (95/149, 63.76%). Additionally, 29 (16.5%) patients were found to have two or more respiratory pathogens. The positive of pathogen varied significantly with the level of CD4⁺ T-lymphocyte count (U = 2 267, P = 0.001), HIV viral load (U = 2 277, P = 0.001) and received highly active antiretroviral therapy or not (χ² = 18.557, P = 0.001). Multivariate Logistic analysis revealed that age was an independent risk factors for pulmonary infection in HIV-infected patients (OR = 1.15, 95%CI: 1.00-1.23, P = 0.038) and CD4⁺ T-lymphocyte count ≥ 112 cells/µl was a protective factor (OR = 0.89, 95%CI: 0.84-0.95, P = 0.001).

Conclusions

The positive detection rate of respiratory pathogens are higher in HIV-infected patients with pulmonary infection. Clarifying respiratory pathogen infection characteristics and immunological characteristics such as CD4⁺ T-lymphocyte count of HIV-infected people is of great significance for the diagnosis and treatment of lung infections. In addition, compared with clinical diagnosis, multiplex real-time PCR detection has higher sensitivity and specificity, which can provide more pathogenic evidence for the diagnosis of HIV complicated with pulmonary infection.

Key words: Human immunodeficiency virus, Pulmonary infection, Immunological characteristics, Multiple real-time polymerase chain reaction, Influencing factor

Xueling Zeng, Siyuan Yang, Yufei Chang, Hongxin Zhao, Linghang Wang. Characteristics of respiratory pathogens and immunological features of 176 patients with human immunodeficiency virus and pulmonary infection[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2024, 18(03): 142-148.

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References 27

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指标	病原体检出组（118例）	病原体未检出组（58例）	统计量	P值
性别[例（%）]
男	117（99.2）	55（94.8）	χ² = 1.617	0.203
女	1（0.8）	3（5.2）	χ² = 1.617	0.203
年龄[M（P25，P75），岁]	37（29，46）	32（27，42）	U= 2 780	0.038
呼吸[M（P25，P75），次/min]	22（20，24）	21（20，22）	U = 2 648	0.01
最高体温[M（P25，P75），℃]	38.40（37.20，39.00）	38.45（37.10，39.10）	U = 3 291	0.681
男男性行为[例（%）]	58（49.2）	32（55.2）	χ² = 1.169	0.557
发热[例（%）]	89（75.4）	47（81.0）	χ² = 0.697	0.404
咳嗽[例（%）]	69（58.5）	25（43.1）	χ² = 3.692	0.055
咯痰[例（%）]	19（16.1）	6（10.3）	χ² = 1.057	0.304
呼吸困难[例（%）]	24（20.3）	1（1.7）	χ² = 11.057	0.001
胸闷[例（%）]	50（42.4）	6（10.3）	χ² = 18.387	< 0.001
盗汗[例（%）]	5（4.2）	6（10.3）	χ² = 1.543	0.214
乏力[例（%）]	4（3.4）	1（1.7）	χ² = 0.020	0.887
淋巴细胞计数[M（P25，P75），× 10⁹/L]	0.77（0.47，1.05）	0.94（0.55，1.33）	U = 2 821	0.059
中性粒细胞计数[M（P25，P75），× 10⁹/L]	3.29（2.41，4.89）	3.04（2.14，5.27）	U = 3 243	0.574
CD4⁺ T淋巴细胞计数[M（P25，P75），cells/µl]	25.5（10，56）	78.5（16，254）	U = 2 267	0.001
HIV病毒载量[M（P25，P75），拷贝/ml]	172 309（69 041，459 782）	36 747（473，200 399）	U = 2 277	0.001
C-反应蛋白[M（P25，P75），mg/L]	32.55（11.1，63.6）	33.8（5.9，73.3）	U = 3 298	0.696
红细胞沉降率[M（P25，P75），mm/h]	61.5（36，77）	62（33，78）	U = 3 372	0.875
HAART治疗[例（%）]	22（18.6）	29（50.0）	χ² = 18.557	0.001
死亡[例（%）]	11（6.3）	0（0.0）	χ² = 4.286	0.038

指标	病原体检出组（118例）	病原体未检出组（58例）	统计量	P值
性别[例（%）]
男	117（99.2）	55（94.8）	χ² = 1.617	0.203
女	1（0.8）	3（5.2）	χ² = 1.617	0.203
年龄[M（P25，P75），岁]	37（29，46）	32（27，42）	U= 2 780	0.038
呼吸[M（P25，P75），次/min]	22（20，24）	21（20，22）	U = 2 648	0.01
最高体温[M（P25，P75），℃]	38.40（37.20，39.00）	38.45（37.10，39.10）	U = 3 291	0.681
男男性行为[例（%）]	58（49.2）	32（55.2）	χ² = 1.169	0.557
发热[例（%）]	89（75.4）	47（81.0）	χ² = 0.697	0.404
咳嗽[例（%）]	69（58.5）	25（43.1）	χ² = 3.692	0.055
咯痰[例（%）]	19（16.1）	6（10.3）	χ² = 1.057	0.304
呼吸困难[例（%）]	24（20.3）	1（1.7）	χ² = 11.057	0.001
胸闷[例（%）]	50（42.4）	6（10.3）	χ² = 18.387	< 0.001
盗汗[例（%）]	5（4.2）	6（10.3）	χ² = 1.543	0.214
乏力[例（%）]	4（3.4）	1（1.7）	χ² = 0.020	0.887
淋巴细胞计数[M（P25，P75），× 10⁹/L]	0.77（0.47，1.05）	0.94（0.55，1.33）	U = 2 821	0.059
中性粒细胞计数[M（P25，P75），× 10⁹/L]	3.29（2.41，4.89）	3.04（2.14，5.27）	U = 3 243	0.574
CD4⁺ T淋巴细胞计数[M（P25，P75），cells/µl]	25.5（10，56）	78.5（16，254）	U = 2 267	0.001
HIV病毒载量[M（P25，P75），拷贝/ml]	172 309（69 041，459 782）	36 747（473，200 399）	U = 2 277	0.001
C-反应蛋白[M（P25，P75），mg/L]	32.55（11.1，63.6）	33.8（5.9，73.3）	U = 3 298	0.696
红细胞沉降率[M（P25，P75），mm/h]	61.5（36，77）	62（33，78）	U = 3 372	0.875
HAART治疗[例（%）]	22（18.6）	29（50.0）	χ² = 18.557	0.001
死亡[例（%）]	11（6.3）	0（0.0）	χ² = 4.286	0.038

指标	β值	S.E.值	Wald χ²值	P值	OR值	95%CI
年龄≥ 37.5岁	0.350	0.170	4.830	0.038	1.150	1.00～1.23
CD4⁺ T淋巴细胞计数≥ 112 cells/µl	0.008	0.001	11.230	< 0.001	0.890	0.84～0.95
常量	－0.575	0.667	0.743	0.389	0.563	—

指标	β值	S.E.值	Wald χ²值	P值	OR值	95%CI
年龄≥ 37.5岁	0.350	0.170	4.830	0.038	1.150	1.00～1.23
CD4⁺ T淋巴细胞计数≥ 112 cells/µl	0.008	0.001	11.230	< 0.001	0.890	0.84～0.95
常量	－0.575	0.667	0.743	0.389	0.563	—

病原体	例次	检出率（%）
耶氏肺孢子菌	95	63.76
肺炎链球菌	1	0.67
肺炎克雷伯菌	3	2.01
结核分枝杆菌	2	1.34
铜绿假单胞菌	4	2.68
金黄色葡萄球菌	4	2.68
鲍曼不动杆菌	2	1.34
流感嗜血杆菌	3	2.01
嗜麦芽窄食单胞菌	7	4.70
卡他莫拉菌	3	2.01
大肠埃希菌	3	2.01
肺炎支原体	2	1.34
肺炎衣原体	1	0.67
腺病毒	2	1.34
冠状病毒229E	6	4.03
甲型流感病毒	6	4.03
乙型流感病毒	3	2.01
副流感病毒Ⅰ型	1	0.67
人偏肺病毒	1	0.67

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