Venkatesh P A, Bosch R J, McIntosh K, Mugusi F, Msamanga G, Fawzi W W
Department of Nutrition, Harvard School of Public Health, Boston, MA 02115, USA.
Int J Tuberc Lung Dis. 2005 Oct;9(10):1105-11.
The development of tuberculosis (TB) in HIV-1-infected individuals is associated with accelerated HIV-1 disease progression.
To examine the predictors of incident TB in HIV-1-infected Tanzanian women.
A prospective cohort of 1078 HIV-1-infected pregnant women was enrolled in a randomized clinical trial to examine the role of vitamin supplements in HIV-1 disease progression and fetal outcomes.
Of 1008 women evaluated for TB, 88 (8.7%) developed TB. After controlling for age, education and hemoglobin concentration, in multivariate analysis, low CD4 cell count, elevated erythrocyte sedimentation rate (ESR), decreased mid-upper arm circumference, and high viremia were associated with an increased risk of TB. CD4 <200 vs. > or = 500 cells/mm3 was associated with a 4.44-fold increase in risk of TB (95%CI 2.10-9.40). Individuals with high viremia (> or = 50,000 copies/ml) had a 2.43-fold increase in risk of TB (95%CI 1.24-4.76). Elevated malarial parasite density was slightly associated with a 65% (95%CI 19-85) decreased risk of TB.
The risk of developing TB was elevated among women with low CD4 cell counts, elevated ESR, coinfections with other pathogens, poor nutrition and high viremia. There is a slight inverse association between malarial infection and TB, possibly because treating malaria may reduce the risk of TB.
在感染HIV-1的个体中，结核病（TB）的发生与HIV-1疾病进展加速相关。
研究感染HIV-1的坦桑尼亚女性发生结核病的预测因素。
一项前瞻性队列研究，纳入1078名感染HIV-1的孕妇，进行一项随机临床试验，以研究维生素补充剂在HIV-1疾病进展和胎儿结局中的作用。
在1008名接受结核病评估的女性中，88名（8.7%）发生了结核病。在控制年龄、教育程度和血红蛋白浓度后，多因素分析显示，CD4细胞计数低、红细胞沉降率（ESR）升高、上臂中部周长减小和病毒血症高与结核病风险增加相关。CD4<200个细胞/mm3与≥500个细胞/mm3相比，结核病风险增加4.44倍（95%CI 2.10-9.40）。病毒血症高（≥50,000拷贝/ml）的个体结核病风险增加2.43倍（95%CI 1.24-4.76）。疟原虫密度升高与结核病风险降低65%（95%CI 19-85）略有相关。
CD4细胞计数低、ESR升高、合并其他病原体感染、营养状况差和病毒血症高的女性发生结核病的风险升高。疟疾感染与结核病之间存在轻微的负相关，可能是因为治疗疟疾可降低结核病风险。
