Kwesigabo G, Killewo J Z, Sandström A, Winani S, Mhalu F S, Biberfeld G, Wall S
Department of Epidemiology and Biostatistics, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania.
AIDS Care. 1999 Feb;11(1):87-93. doi: 10.1080/09540129948225.
In order to estimate hospital HIV prevalence, the economic impact of AIDS on health care and to assess the implications of HIV testing on clinical suspicion of AIDS this hospital based study was done at the government regional hospital of Kagera, Tanzania. Consecutive admissions were recruited into the study, and those consenting had a blood specimen taken, one portion of which was used to aid clinical diagnosis, while the other was tested anonymously for HIV antibodies using two ELISA systems. A short questionnaire was used to specify demographic characteristics, hospital ward of admission and diagnosis of each study subject. The overall age adjusted HIV-1 prevalence was 32.8% (N = 1422) and there was no significant difference in the age adjusted sex specific prevalence. The highest prevalence (53.3%) was found in the 25-34 years age group as well as in the gynaecological and medical wards (41.2% and 40.4%, respectively). The diagnostic category of clinical AIDS had a sensitivity of 11.3% and a specificity of 99.3%, indicating that only 11.3% of the HIV seropositives would have been HIV tested on clinical suspicion of AIDS. Similarly, the HIV-1 antibody sensitivity and specificity for tuberculosis were 5.9% and 97.9%, respectively. Patients who were HIV-1 infected were more likely to have a history of previous hospital admissions, RR = 1.34 (95% CI = 1.16-1.56), and were at an increased risk of developing tuberculosis, RR = 2.02 (95% CI = 1.50-2.70). The diagnostic categories with the highest HIV-1 infection prevalence were clinical AIDS (88.5%), herpes zoster and other HIV-1 skin manifestations combined (85.7%) and pulmonary tuberculosis (58.3%). In conclusion, the prevalence of HIV-1 infection was high among hospitalized patients in Bukoba hospital indicating that the major cause of illness leading to admission to the hospital may have been underlying HIV-1 infection. The findings also indicate that in a high HIV-1 prevalence area, testing for HIV infection on the basis of clinical suspicion of AIDS alone is not sufficient to provide rational care to the majority of HIV infected patients.
为了估算医院内艾滋病毒的流行情况、艾滋病对医疗保健的经济影响以及评估基于临床怀疑艾滋病进行艾滋病毒检测的意义，在坦桑尼亚卡盖拉的政府地区医院开展了这项基于医院的研究。连续入院的患者被纳入研究，同意参与的患者采集血样，一部分用于辅助临床诊断，另一部分则使用两种酶联免疫吸附测定（ELISA）系统进行艾滋病毒抗体匿名检测。使用一份简短问卷来明确每位研究对象的人口统计学特征、入院科室及诊断情况。经年龄调整后的艾滋病毒-1总体流行率为32.8%（N = 1422），经年龄调整后的按性别划分的流行率无显著差异。25 - 34岁年龄组以及妇科和内科病房的流行率最高（分别为53.3%、41.2%和40.4%）。临床艾滋病诊断类别的灵敏度为11.3%，特异度为99.3%，这表明在临床怀疑艾滋病时，只有11.3%的艾滋病毒血清阳性者会接受艾滋病毒检测。同样，艾滋病毒-1抗体对结核病的灵敏度和特异度分别为5.9%和97.9%。感染艾滋病毒-1的患者更有可能有既往住院史，相对危险度（RR）= 1.34（95%置信区间[CI] = 1.16 - 1.56），且患结核病的风险增加，RR = 2.02（95% CI = 1.50 - 2.70）。艾滋病毒-1感染流行率最高的诊断类别为临床艾滋病（88.5%）、带状疱疹及其他艾滋病毒-1皮肤表现合并症（85.7%）和肺结核（58.3%）。总之，布科巴医院住院患者中艾滋病毒-1感染流行率较高，这表明导致入院的主要病因可能是潜在的艾滋病毒-1感染。研究结果还表明，在艾滋病毒-1高流行地区，仅基于临床怀疑艾滋病进行艾滋病毒感染检测不足以向大多数艾滋病毒感染患者提供合理的治疗。
