Sackoff J E, Torian L V, Frieden T R
New York City Department of Health, Office of AIDS Research, New York 10013, USA.
Int J Tuberc Lung Dis. 2001 Feb;5(2):123-8.
Ten hospital-based human immunodeficiency virus (HIV) clinics in New York City.
To evaluate tuberculosis (TB) prevention in HIV clinics based on the prevalence and incidence of TB and the efficacy of preventive therapy with isoniazid (INH).
The medical records of 2393 HIV-infected patients with a first clinic visit in 1995 were reviewed retrospectively. Deaths and TB cases through December 1997 were ascertained through a match with the TB and AIDS registries.
At first visit, 92 patients (4%) had a history of TB, 98 (4%) were being treated for TB, and six (<1%) were diagnosed with TB. During follow-up, 23 cases were diagnosed, an incidence of 0.53 per 100 person-years (py) (95%CI 0.34-0.77). Among 439 tuberculin skin test (TST) positive patients, the incidence of TB/100 py was 1.63 (95%CI 0.27-5.02) in patients with no INH, 1.28 (95%CI 0.40-2.98) in patients with <12 months of INH, and 1.06 (95%CI 0.38-2.28) in patients with 12 months of INH. The incidence/100 py was 0.0 (95%CI 0.0-0.78) in TST-negative patients and 0.37 (95%CI 0.09-0.95) in anergic patients. The relative risk of TB was 0.65 (95%CI 0.14-4.56) in TST-positive patients with 12 months of INH (vs. none).
The benefits of TB prevention efforts in these HIV clinics from 1995 to 1997 were limited because most TB occurred before the first clinic visit. Methods for reaching HIV-infected patients earlier should be identified.
纽约市的十家医院型人类免疫缺陷病毒（HIV）诊所。
基于结核病（TB）的患病率和发病率以及异烟肼（INH）预防性治疗的疗效，评估HIV诊所中的结核病预防情况。
回顾性分析了1995年首次到诊所就诊的2393例HIV感染患者的病历。通过与结核病和艾滋病登记处匹配，确定了截至1997年12月的死亡病例和结核病病例。
初诊时，92例患者（4%）有结核病病史，98例（4%）正在接受结核病治疗，6例（<1%）被诊断为结核病。随访期间，确诊23例，发病率为每100人年0.53例（95%可信区间0.34 - 0.77）。在439例结核菌素皮肤试验（TST）阳性患者中，未接受INH治疗的患者结核病发病率/100人年为1.63（95%可信区间0.27 - 5.02），接受INH治疗<12个月的患者为1.28（95%可信区间0.40 - 2.98），接受INH治疗12个月的患者为1.06（9�%可信区间0.38 - 2.28）。TST阴性患者的发病率/100人年为0.0（95%可信区间0.0 - 0.78），无反应性患者为0.37（95%可信区间0.09 - 0.95）。接受INH治疗12个月的TST阳性患者（与未接受治疗者相比）结核病的相对风险为0.65（95%可信区间0.14 - 4.56）。
1995年至1997年期间，这些HIV诊所结核病预防工作的益处有限，因为大多数结核病发生在首次诊所就诊之前。应确定更早接触HIV感染患者的方法。
