Changing trends of the pathogenic spectrum of pulmonary infections in patients with human immunodeficiency virus infection/acquired immunodeficiency syndrome from 2017 to 2022
Objective To analyze the changes of pathogen spectrum of pulmonary infection in human immunodeficiency virus(HIV)infection/acquired immunodeficiency syndrome(AIDS)patients before and during coronavirus disease 2019(COVID-19)epidemic.Methods The clinical data of hospitalized HIV infection/AIDS patients with pulmonary infection confirmed by etiology and/or imaging examinations in the Department of Infection and Immunity,Shanghai Public Health Clinical Center,Fudan University from January 2017 to December 2022 were collected,including the types of pathogens,the peripheral blood CD4+T lymphocyte counts at admission due to pulmonary infection,and the treatment outcome of the patients at discharge.The changes of pathogen spectrum of pulmonary infection before COVID-19 epidemic(2017 to 2019)and during the epidemic(2020 to 2022)were analyzed,and their effects on adverse treatment outcomes(death during hospitalization or automatic discharge)were analyzed.Statistical analysis was performed using the chi-square test,trend chi-square test or Kruskal-Wallis test.Results The proportion of patients with pulmonary infection during the epidemic was lower than that before the epidemic,the difference was statistically significant(23.01％(1 061/4 612)vs 28.68％(1 463/5 102),x2=40.76,P＜0.001).From 2017 to 2022,the proportion of hospitalized HIV infection/AIDS patients with pulmonary infection showed a downward trend(x2trend=8.81,P＜0.001).Among the pathogens causing pulmonary infection from 2017 to 2022,bacteria,mycobacteria,and fungi were the three main pathogenic pathogens,accounting for 48.77％(1 231/2 524),32.13％(811/2 524),and 14.34％(362/2 524),respectively.The proportion of bacterial infection decreased from 55.02％(805/1 463)before the epidemic to 40.15％(426/1 061)during the epidemic,and the proportion of fungal infection increased from 9.23％(135/1 463)to 21.39％(227/1 061),the differences were both statistically significant(x2=54.45 and 74.11,respectively,both P＜0.001).There was no significant difference in the proportion of mycobacteria between before and during the epidemic(P=0.169),but the proportion of Mycobacterium tuberculosis(MTB)infection decreased from 22.01％(322/1 463)before the epidemic to 15.08％(160/1 061)during the epidemic,while the proportion of nontuberculous mycobacterium(NTM)infection increased from 7.11％(104/463)to 11.78％(125/1 061),the differences were both statistically significant(x2=19.11 and 16.28,respectively,both P＜0.001).There was a significant difference in the pathogen spectrum of pulmonary infection before and during the epidemic(x2=128.91,P＜0.001).There was a significant difference in the peripheral blood CD4+T lymphocyte counts of patients with MTB,NTM,Pnenmocystis,Talaromycosis marneffei and Cryptococcus infection(H=71.92,P＜0.001).There were 63.74％(109/171)of Pneumocystis infection and 67.65％(69/102)of Talaromycosis marneffei infection occurred in patients with CD4+T lymphocyte count＜50/µL.Among the patients with pulmonary infection,the proportion of patients with adverse treatment outcomes during the epidemic was higher than that before the epidemic,and the difference was statistically significant(13.29％(141/1 061)vs 10.39％(152/1 463),x2=5.04,P=0.025).Among the patients with pulmonary infection who developed adverse treatment outcomes,the top three pathogens(from high to low)were bacteria(63.48％(186/293)),mycobacteria(27.65％(81/293)),and fungi(6.8 3％(20/293)).The proportion of adverse treatment outcomes caused by bacterial infection decreased during the epidemic compared with that of before the epidemic(71.71％(109/152)vs 54.61％(77/141),x2=9.23,P=0.002),while the proportion of adverse treatment outcomes caused by fungal infection increased(2.63％(4/152)vs 11.35％(16/141),x2=8.74,P=0.003),and the differences were both statistically significant.The proportion of adverse treatment outcomes caused by mycobacterial infection increased,but without statistically significant(23.03％(35/152)vs 32.62％(46/141),X2=3.37,P=0.066),among which there was no difference in the proportion of adverse treatment outcomes caused by MTB infection(13.82％(21/152)vs 14.89％(21/141),x2=0.07,P=0.793),while the proportion of adverse treatment outcomes caused by NTM infection increased(5.92％(9/152)vs 14.89％(21/141),x2=6.41,P=0.011).There was a significant difference in the pathogen spectrum of pulmonary infection patients with adverse treatment outcomes before and during the epidemic(x2=12.22,P=0.007).Conclusions Among the spectrum of pathogens causing pulmonary infection and adverse treatment outcomes of HIV infection/AIDS patients during the epidemic,compared with that before the epidemic,the proportion of bacterial decreases,while the proportion of fungi increases,and the proportion of mycobacteria remains stable with the proportion of NTM increasing.The proportion of MTB causing pulmonary infection decreases,while the proportion of MTB causing adverse treatment outcomes remains stable.
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