Calpe J L, Chiner E, Marín-Pardo J, Calpe A, Armero V
Pneumology Service, Hospital Marina Baixa, Alicante 03570, Spain.
Int J Tuberc Lung Dis. 2004 Oct;8(10):1204-12.
Area 15 in Valencia.
To describe the epidemiology (1987-2001) of tuberculosis (TB) in human immunodeficiency virus (HIV) patients.
Study of annual incidence, age distribution, excess cases attributed to HIV, etiological risk fraction (ERF), population attributable fraction (PAF) and f factor.
Of 476 cases diagnosed, 459 were TB, 16 environmental and one mixed; 76% of environmental cases were HIV-positive (P < 0.001). There was a mean annual TB incidence of 24.6/100000, with an annual reduction of 4%. Seventy-three patients were HIV coinfected (16%) (mean incidence 3834/100 000 seropositives). The principal risk factor was drug use (59%) for HIV+ and contact with TB for HIV-. We found no difference in pulmonary or extra-pulmonary location between groups, contrary to mixed cases (P < 0.001). In HIV+ there was a lower frequency of infiltrates (P < 0.001) and cavitation (P < 0.01), and a higher frequency of adenitis (P < 0.001), miliary or nodular pattern and normal X-ray (P < 0.001). Seropositives had a 174 times higher probability of developing TB. The mean ERF attributed to HIV was 99%, the PAF was 16% and the f factor was 1.19. Highly active antiretroviral therapy (HAART) reduced the risk of TB in HIV+ by 80%.
TB has continued its decline, although HIV generated an excess of cases in the 1990s. HAART has reduced the TB risk in HIV+ and possibly the overall rate of TB.
瓦伦西亚的第15区。
描述人类免疫缺陷病毒（HIV）感染者中结核病（TB）的流行病学情况（1987 - 2001年）。
研究年发病率、年龄分布、归因于HIV的额外病例、病因风险分数（ERF）、人群归因分数（PAF）和f因子。
在确诊的476例病例中，459例为结核病，16例为环境性病例，1例为混合性病例；76%的环境性病例HIV呈阳性（P < 0.001）。结核病的年平均发病率为24.6/100000，年降幅为4%。73例患者合并感染HIV（16%）（平均发病率为3834/100000血清阳性者）。主要危险因素在HIV阳性者中为药物使用（59%），在HIV阴性者中为接触结核病。我们发现两组在肺部或肺外部位无差异，混合性病例情况相反（P < 0.001）。在HIV阳性者中，浸润的频率较低（P < 0.001），空洞形成的频率较低（P < 0.01），而腺炎的频率较高（P < 0.001），粟粒状或结节状模式及X线正常的频率较高（P < 0.001）。血清阳性者患结核病的可能性高174倍。归因于HIV的平均ERF为99%，PAF为16%，f因子为1.19。高效抗逆转录病毒治疗（HAART）使HIV阳性者患结核病风险降低80%。
结核病发病率持续下降，尽管在20世纪90年代HIV导致了额外病例。HAART降低了HIV阳性者患结核病的风险，可能也降低了结核病的总体发病率。
