纽约市人类免疫缺陷病毒感染的结核病患者队列中的生存情况。对扩大艾滋病病例定义的影响。

Survival in a cohort of human immunodeficiency virus-infected tuberculosis patients in New York City. Implications for the expansion of the AIDS case definition.

作者信息

Stoneburner R, Laroche E, Prevots R, Singh T, Blum S, Terry P, Reatrice S, Adler J

机构信息

New York City Department of Health, Mount Sinai Medical Center, New York.

出版信息

Arch Intern Med. 1992 Oct;152(10):2033-7.

PMID:1358042

Abstract

BACKGROUND

The occurrence of pulmonary tuberculosis in human immunodeficiency virus (HIV)-infected persons is believed to represent a less severe stage of HIV-related disease with a more favorable prognosis than other acquired immunodeficiency syndrome (AIDS)-defining conditions; therefore, it has been excluded from the AIDS definition established by the Centers for Disease Control (Atlanta, Ga) criteria.

METHODS

To determine the prognosis of patients with HIV-related tuberculosis, we assessed the clinical, immunologic, and HIV infection status of a cohort of male subjects aged 20 to 44 years who were hospitalized with tuberculosis but without AIDS in New York City hospitals from 1985 through 1986, and we determined their mortality through May 1991.

RESULTS

The 58 patients who agreed to participate were largely (90%) nonwhite and had a high prevalence of pulmonary tuberculosis (90%) and HIV infection (53%). Patients who were HIV seropositive had significantly lower CD4 cell counts (median, 0.136 x 10(9)/L; range, 0.013 x 10(9) to 2.314 x 10(9)/L vs median, 0.765 x 10(9)/L; range, 0.284 x 10(9) to 2.333 x 10(9)/L), and, during the follow-up period, an 83% mortality rate that was 7.5 times higher than the 11% rate in seronegative subjects. Survival analyses revealed that for all HIV-seropositive subjects the probability of death at 30 months was 72% and the median survival was 21 months (95% confidence interval, 15.5 to 26.5 months), while for HIV-seropositive subjects with CD4 cell counts of 0.2 x 10(9)/L or less, the probability of death at 30 months was 92% and the median survival was 15.75 months (95% confidence interval, 14.0 to 17.6 months).

CONCLUSION

The prognosis for patients with HIV-related pulmonary tuberculosis is poor, and those with CD4 cell counts of 0.2 x 10(9)/L or less have survival patterns similar to that of patients with AIDS. We believe that these data support the expansion of the AIDS case definition to include persons with both pulmonary tuberculosis and severe HIV-related immunosuppression.

摘要

背景

人类免疫缺陷病毒（HIV）感染者中肺结核的发生被认为代表了HIV相关疾病的一个不太严重阶段，与其他获得性免疫缺陷综合征（AIDS）定义的疾病相比预后更佳；因此，它被排除在疾病控制中心（佐治亚州亚特兰大）制定的艾滋病定义之外。

方法

为了确定HIV相关肺结核患者的预后，我们评估了1985年至1986年在纽约市医院因肺结核住院但未患艾滋病的20至44岁男性受试者队列的临床、免疫和HIV感染状况，并确定了他们至1991年5月的死亡率。

结果

同意参与的58名患者大多（90%）为非白人，肺结核患病率（90%）和HIV感染率（53%）都很高。HIV血清反应阳性的患者CD4细胞计数显著更低（中位数为0.136×10⁹/L；范围为0.013×10⁹至2.314×10⁹/L，而血清反应阴性的患者中位数为0.765×10⁹/L；范围为0.284×10⁹至2.333×10⁹/L），并且在随访期间，死亡率为83%，是血清反应阴性受试者11%死亡率的7.5倍。生存分析显示，所有HIV血清反应阳性受试者在30个月时的死亡概率为72%，中位生存期为21个月（95%置信区间，15.5至26.5个月），而CD4细胞计数为0.2×10⁹/L或更低的HIV血清反应阳性受试者在30个月时的死亡概率为92%，中位生存期为15.75个月（95%置信区间，14.0至17.6个月）。