Wolday D, Hailu B, Girma M, Hailu E, Sanders E, Fontanet A L
Ethiopian Health and Nutrition Research Institute, Ethio-Netherlands AIDS Research Project, Addis Ababa, Ethiopia.
Int J Tuberc Lung Dis. 2003 Feb;7(2):110-6.
Prospective cohort study, Ethiopia.
To study changes in biological markers of HIV infection progression before and after development of TB disease.
A longitudinal study of 804 adult factory workers (95 HIV-positive, 709 HIV-negative), who were followed every 6 months for a median of 3.8 years.
Overall, the incidence rate of TB was 10/ 222 = 45.1 (95%CI 24.3-83.9) per 1000 person-years of observation (PYO) among HIV-1-positive participants, compared to 14/2,054 = 6.8 (95%CI 4.0-11.5) per 1,000 PYO among HIV-1-negative participants (incidence rate ratio 6.62, 95%CI 2.94-14.9). Among the 10 HIV-positive participants who subsequently developed TB disease, the CD4 count was low (median 201/microl, range 45-419), and viral load high (median 4.97 log copies/ml, range 3.70-5.58), at the routine follow-up visit prior to TB diagnosis. Following TB treatment, plasma viral load remained persistently elevated despite clinical resolution of TB disease, and seven of the 10 patients died within a median time of 8 months.
In this cohort, HIV-infected Ethiopians who developed TB disease already had low CD4 counts and high viral load prior to the diagnosis of TB. Viral load did not decrease following TB treatment, leading to a poor overall prognosis in these patients.
前瞻性队列研究，埃塞俄比亚。
研究结核病发生前后HIV感染进展的生物学标志物变化。
对804名成年工厂工人（95名HIV阳性，709名HIV阴性）进行纵向研究，每6个月随访一次，中位随访时间为3.8年。
总体而言，HIV-1阳性参与者中结核病的发病率为每1000人年观察期（PYO）10/222 = 45.1（95%CI 24.3 - 83.9），而HIV-1阴性参与者中为每1000 PYO 14/2054 = 6.8（95%CI 4.0 - 11.5）（发病率比6.62，95%CI 2.94 - 14.9）。在随后发生结核病的10名HIV阳性参与者中，结核病诊断前的常规随访中CD4细胞计数较低（中位值201/微升，范围45 - 419），病毒载量较高（中位值4.97 log拷贝/毫升，范围3.70 - 5.58）。结核病治疗后，尽管结核病临床治愈，但血浆病毒载量持续升高，10名患者中有7名在中位时间8个月内死亡。
在该队列中，发生结核病的HIV感染埃塞俄比亚人在结核病诊断前CD4细胞计数就已较低且病毒载量较高。结核病治疗后病毒载量未降低，导致这些患者总体预后较差。
