Girardi E, Antonucci G, Vanacore P, Libanore M, Errante I, Matteelli A, Ippolito G
Centro di Riferimento AIDS--Servizio di Epidemiologia delle Malattie Infettive, IRCCS L. Spallanzani, Rome, Italy.
AIDS. 2000 Sep 8;14(13):1985-91. doi: 10.1097/00002030-200009080-00015.
To assess the association between use of different antiretroviral regimens and incidence of tuberculosis among HIV-infected individuals.
Observational, multicenter, prospective cohort study.
Twenty-eight infectious diseases hospital units in Italy. A total of 2160 HIV-infected persons were considered for enrolment in a study on the implementation of tuberculosis preventive therapy between 1 May 1995 and 30 April 1996. The 1360 subjects who completed tuberculin screening at base-line were included in this analysis. Information on the use of antiretroviral therapies over time was collected. The median duration of follow-up was 104 weeks and 997 subjects (73.3%) completed the study.
Incidence of active tuberculosis according to different types of antiretroviral therapy.
Eighteen cases of tuberculosis were observed with an overall incidence rate of 0.79 per 100 person-years of observation [95% confidence interval (CI), 0.51-1.31]. Tuberculin positivity and low CD4+ lymphocyte count were the only base-line variables independently associated with the risk of tuberculosis. During follow-up, 637 patients took double combination antiretroviral therapy and 387 took triple combination therapy. After adjusting for base-line characteristics of enrolled individuals, the relative hazard of tuberculosis was 0.16 (95% CI, 0.03-0.74) for double combination therapy and 0.08 (95% CI, 0.01-0.88) for triple combination therapy compared with no therapy or monotherapy.
Combination antiretroviral therapy significantly reduced the risk of tuberculosis in HIV-infected persons. In industrialized countries, the widespread use of this treatment may determine a decrease in the incidence of HIV-associated tuberculosis, possibly contributing to a reduction in the overall incidence of tuberculosis.
评估不同抗逆转录病毒治疗方案的使用与HIV感染者中结核病发病率之间的关联。
观察性、多中心、前瞻性队列研究。
意大利的28个传染病医院科室。在1995年5月1日至1996年4月30日期间，共有2160名HIV感染者被纳入一项关于实施结核病预防性治疗的研究。本分析纳入了1360名在基线时完成结核菌素筛查的受试者。收集了随时间推移使用抗逆转录病毒疗法的信息。随访的中位持续时间为104周，997名受试者（73.3%）完成了研究。
根据不同类型的抗逆转录病毒治疗，活动性结核病的发病率。
观察到18例结核病病例，总发病率为每100人年观察期0.79例[95%置信区间（CI），0.51 - 1.31]。结核菌素阳性和低CD4 +淋巴细胞计数是与结核病风险独立相关的仅有的基线变量。在随访期间，637名患者接受了双药联合抗逆转录病毒治疗，387名患者接受了三药联合治疗。在调整了纳入个体的基线特征后，与未治疗或单药治疗相比，双药联合治疗的结核病相对风险为0.16（95%CI，0.03 - 0.74），三药联合治疗为0.08（95%CI，0.01 - 0.88）。
抗逆转录病毒联合治疗显著降低了HIV感染者患结核病的风险。在工业化国家，这种治疗方法的广泛使用可能会使HIV相关结核病的发病率下降，可能有助于降低结核病的总体发病率。
