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HIV-1感染的结核病患者中结核分枝杆菌的传染性:一项前瞻性研究。

Infectiousness of Mycobacterium tuberculosis in HIV-1-infected patients with tuberculosis: a prospective study.

作者信息

Espinal M A, Peréz E N, Baéz J, Hénriquez L, Fernández K, Lopez M, Olivo P, Reingold A L

机构信息

National Centre for Research on Maternal and Child Health, Santo Domingo, Dominican Republic.

出版信息

Lancet. 2000 Jan 22;355(9200):275-80. doi: 10.1016/S0140-6736(99)04402-5.

Abstract

BACKGROUND

Previous studies concerning the relative infectiousness of HIV-1-positive individuals with pulmonary tuberculosis have produced conflicting results. Thus, we assessed the effect of HIV-1 on the infectiousness of Mycobacterium tuberculosis in a prospective study.

METHODS

We organised in Santo Domingo, Dominican Republic, a cohort study of household contacts of HIV-1-positive and HIV-1-negative individuals with newly diagnosed pulmonary tuberculosis. Household contacts were assessed at their houses at baseline and followed up for 14 months for evidence of M tuberculosis infection and tuberculosis with a multi-step tuberculin skin test, anergy skin test, physical examinations, chest radiographs, and sputum smears.

FINDINGS

Tuberculin induration of 5 mm or greater was seen in 153 (61%) of 252 household contacts of HIV-1-positive index cases and in 418 (76%) of 551 household contacts of HIV-1-negative index cases (odds ratio 0.49 [95% CI 0.35-0.67], p=0.00001). In multivariate logistic-regression analysis after allowance for between-household variation in tuberculin response, HIV-1 infection of the index case remained inversely associated with the tuberculin response of the household contacts (0.52 [0.29-0.93], p=0.02). When the analysis was restricted to household contacts aged between 2 years and 15 years the adjusted association remained significant (0.37 [0.14-0.98], p=0.04). Among household contacts who had a negative tuberculin skin test at baseline, conversion to tuberculin skin test positivity was less frequent among household contacts of HIV-1-positive index cases (cut-off > or =5 mm: 32/131 [24%] vs 71/204 [35%], p=0.05; cut-off > or =10 mm: 23/153 [15%] vs 55/245 [22%], p=0.07).

INTERPRETATION

These data suggest that HIV-1-positive individuals with tuberculosis are less likely than HIV-1-negative individuals with tuberculosis to transmit M tuberculosis to their close contacts. No changes in the current policy regarding tuberculosis contact tracing are needed in the presence of HIV-1.

摘要

背景

先前有关HIV-1阳性肺结核患者相对传染性的研究结果相互矛盾。因此,我们在一项前瞻性研究中评估了HIV-1对结核分枝杆菌传染性的影响。

方法

我们在多米尼加共和国圣多明各组织了一项队列研究,研究对象为新诊断为肺结核的HIV-1阳性和HIV-1阴性个体的家庭接触者。在基线时对家庭接触者进行家访评估,并随访14个月,通过多步结核菌素皮肤试验、无反应性皮肤试验、体格检查、胸部X光片和痰涂片来检测结核分枝杆菌感染和结核病证据。

结果

在252名HIV-1阳性索引病例的家庭接触者中,有153人(61%)结核菌素硬结直径达到或超过5毫米;在551名HIV-1阴性索引病例的家庭接触者中,有418人(76%)结核菌素硬结直径达到或超过5毫米(比值比0.49 [95% CI 0.35 - 0.67],p = 0.00001)。在考虑家庭间结核菌素反应差异后进行多变量逻辑回归分析,索引病例的HIV-1感染仍与家庭接触者的结核菌素反应呈负相关(0.52 [0.29 - 0.93],p = 0.02)。当分析仅限于年龄在2岁至15岁之间的家庭接触者时,校正后的关联仍然显著(0.37 [0.14 - 0.98],p = 0.04)。在基线时结核菌素皮肤试验为阴性的家庭接触者中,HIV-1阳性索引病例的家庭接触者结核菌素皮肤试验转为阳性的频率较低(截断值≥5毫米:32/131 [24%] 对71/204 [35%],p = 0.05;截断值≥10毫米:23/153 [15%] 对55/245 [22%],p = 0.07)。

解读

这些数据表明,与HIV-1阴性肺结核患者相比,HIV-1阳性肺结核患者将结核分枝杆菌传播给其密切接触者的可能性较小。在存在HIV-1的情况下,当前关于结核病接触者追踪的政策无需改变。

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