Korzeniewska-Kosela M, FitzGerald J M, Vedal S, Allen E A, Schechter M T, Lawson L, Phillips P, Black W, Montaner J S
Department of Medicine, University of British Columbia, Vancouver.
CMAJ. 1992 Jun 1;146(11):1927-34.
To review the clinical features, treatment and outcome of all known cases of tuberculosis in patients with human immunodeficiency virus (HIV) infection in British Columbia between 1984 and 1990.
Retrospective case review.
Provincial tuberculosis registry and university-affiliated HIV clinic.
All people with HIV infection in whom active tuberculosis was diagnosed during the study period.
All 40 patients identified were men; their mean age was 38 years. Of the subjects 30 (75%) were homosexual, 6 (15%) were homosexual and used intravenous drugs, 2 (5%) just used intravenous drugs, and 1 (2%) had had heterosexual contact with prostitutes; for the remaining subject the risk factor for HIV infection was not established. In all cases cultures of specimens from 15 body sources yielded Mycobacterium tuberculosis. Thirty-five of the patients had acquired immunodeficiency syndrome (AIDS), and five had HIV infection uncomplicated except for tuberculosis. In 28 (70%) of the cases no AIDS-defining disease had previously been diagnosed, and in 23 (58%) extrapulmonary tuberculosis represented the AIDS-defining disease. Symptoms at presentation included weight loss (in 80% of the cases), fever (in 75%), cough (in 70%) and night sweats (in 55%). The mean CD4 lymphocyte count was 0.2 x 10(9)/L (in 15 cases). Tuberculin skin test results were positive in 8 of 16 cases. The most striking radiologic finding was intrathoracic adenopathy. All except one of the 36 patients who received appropriate treatment responded favourably at first. Adverse reactions necessitating changes in treatment occurred in 12 (33%) of the cases. Relapse occurred after completion of therapy in two cases (one at 3 weeks and the other at 9 months after treatment was stopped). Tuberculosis was the cause of death in five cases.
Tuberculosis in people with HIV infection commonly presents as extrapulmonary disease and precedes or coincides with other AIDS-defining opportunistic infections. In most cases tuberculosis is the AIDS-defining disease. Even though radiologic findings are often unusual physicians should suspect tuberculosis. A careful examination for evidence of disease at multiple sites should be done. The duration and choice of therapy must be adequate to avoid relapse.
回顾1984年至1990年间不列颠哥伦比亚省所有已知的人类免疫缺陷病毒（HIV）感染患者的结核病病例的临床特征、治疗及转归。
回顾性病例分析。
省级结核病登记处及大学附属HIV诊所。
研究期间所有确诊为活动性结核病的HIV感染者。
共确定40例患者，均为男性，平均年龄38岁。其中30例（75%）为同性恋者，6例（15%）为同性恋且使用静脉注射毒品者，2例（5%）仅使用静脉注射毒品者，1例（2%）与妓女有异性接触；其余患者的HIV感染危险因素未明确。所有病例中，来自15个身体部位的标本培养均检出结核分枝杆菌。35例患者患有获得性免疫缺陷综合征（AIDS），5例除结核病外无其他并发症。28例（70%）病例此前未诊断出AIDS定义疾病，23例（58%）肺外结核为AIDS定义疾病。就诊时症状包括体重减轻（80%病例）、发热（75%）、咳嗽（70%）及盗汗（55%）。平均CD4淋巴细胞计数为0.2×10⁹/L（15例）。16例中8例结核菌素皮肤试验结果为阳性。最显著的放射学表现为胸内淋巴结肿大。36例接受适当治疗的患者中，除1例外，其余起初反应良好。12例（33%）病例出现需要改变治疗的不良反应。2例患者治疗结束后复发（1例在停药后3周，另1例在9个月）。5例患者死于结核病。
HIV感染者的结核病通常表现为肺外疾病，先于或与其他AIDS定义的机会性感染同时出现。多数情况下，结核病为AIDS定义疾病。尽管放射学表现常不典型，但医生应怀疑结核病。应仔细检查多个部位有无疾病证据。治疗的持续时间和选择必须足够以避免复发。
