结核病对初始CD4淋巴细胞计数较高的HIV感染患者病程的影响。

Impact of tuberculosis on the course of HIV-infected patients with a high initial CD4 lymphocyte count.

作者信息

Mañas E, Pulido F, Peña J M, Rubio R, Gonzalez-García J, Costa R, Pérez-Rodríguez E, Del Palacio A

机构信息

Departamento de Neumología, Hospital Ramón y Cajal, Madrid, Spain.

出版信息

Int J Tuberc Lung Dis. 2004 Apr;8(4):451-7.

PMID:15141738

Abstract

OBJECTIVE

To assess the influence of tuberculosis (TB) on the progression of human immunodeficiency virus (HIV) infection in patients without immunological impairment.

MATERIAL AND METHODS

In an observational study of retrospective cohorts, the evolution of 28 HIV-infected patients with TB and a CD4 lymphocyte count >500 x 10(6) cells/l was compared with 56 HIV-infected patients without TB. Each case was paired with two controls by CD4 lymphocyte count (+/-50 x 10(6)/l) and date of starting follow-up (+/-6 months). The progression of HIV infection was evaluated as: 1) immunological progression: time to CD4 lymphocyte count <200 x 10(6)/l; 2) clinical progression: time to development of acquired immune-deficiency syndrome (AIDS), excluding TB; 3) survival; and 4) global disease progression: time to the first defined event in 1, 2 and/or 3. The times to these events were estimated using Kaplan Meier curves.

RESULTS

There were no significant differences between the cohorts for age, sex and risk group. Faster immunological impairment (RR 2.94; 95%CI 1.46-8.6; P < 0.01), greater progression to AIDS (RR 4.01; 95%CI 1.66-9.69; P < 0.01), lower survival (RR 3.89; 95%CI 1.53-9.87; P < 0.05) and higher global disease progression (RR 2.82; 95%CI 1.57-5.09; P < 0.01) were found in the cohort of TB patients. These associations were still significant after adjustment for CD4 lymphocyte counts.

CONCLUSION

The diagnosis of TB in HIV-infected patients with a high initial CD4 lymphocyte count (>500 x 10(6)/l) was related to greater progression to AIDS and shorter survival.

摘要

目的

评估结核病（TB）对无免疫功能损害的人类免疫缺陷病毒（HIV）感染患者病情进展的影响。

材料与方法

在一项回顾性队列观察研究中，将28例合并结核病且CD4淋巴细胞计数>500×10⁶个/升的HIV感染患者的病情演变情况，与56例未患结核病的HIV感染患者进行比较。根据CD4淋巴细胞计数（±50×10⁶/升）和开始随访日期（±6个月），为每个病例匹配两名对照。HIV感染的病情进展评估如下：1）免疫进展：CD4淋巴细胞计数降至<200×10⁶个/升的时间；2）临床进展：出现获得性免疫缺陷综合征（AIDS，不包括结核病）的时间；3）生存情况；4）整体疾病进展：出现1、2和/或3中首个明确事件的时间。使用Kaplan-Meier曲线估计这些事件发生的时间。

结果

各队列在年龄、性别和风险组方面无显著差异。结核病患者队列中出现了更快的免疫功能损害（风险比[RR]2.94；95%置信区间[CI]1.46 - 8.6；P<0.01）、向AIDS的更大进展（RR 4.01；95%CI 1.66 - 9.69；P<0.01）、更低的生存率（RR 3.89；95%CI 1.53 - 9.87；P<0.05）以及更高的整体疾病进展（RR 2.82；95%CI 1.57 - 5.09；P<0.01）。在对CD4淋巴细胞计数进行校正后，这些关联仍然显著。