Lee L M, Lobato M N, Buskin S E, Morse A, Costa O S
Division of HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
Int J Tuberc Lung Dis. 2006 Feb;10(2):209-14.
Persons infected with human immunodeficiency virus (HIV) are at risk for developing tuberculosis (TB) if latent TB infection remains untreated.
To assess missed opportunities for preventing TB by selecting a population-based sample of 1093 persons diagnosed with HIV from June 1995 to June 1997 in Seattle, WA, New Orleans, LA, and Jersey City, NJ.
To determine the proportion of persons receiving a tuberculin skin test (TST) following HIV diagnosis, we conducted record reviews at providers and local TB control.
An estimated 53.7% (95% CI 49.9-57.4) had a TST following HIV diagnosis; 6.6% (95% CI 4.3-8.9%) of TST-tested patients were reactive. Median time between HIV diagnosis and TST was 1 month (mean 5.7 months, 95% CI 4.8-6.5). Factors associated with TST included additional risk factors for TB (OR 1.76, 95% CI 1.17-2.63), history of HIV-related preventive treatment (OR 5.84, 95% CI 3.74-8.75), higher number of clinic visits (OR 4.16, 95% CI 2.01-8.02), and attendance at facilities with a written policy to provide TST for all persons with HIV (OR 2.54, 95% CI 1.28-4.88).
About half of persons newly diagnosed with HIV infection had a TST following HIV diagnosis, with little variation by demographics, signaling a general need to improve interventions to prevent TB.
如果潜伏性结核感染得不到治疗，感染人类免疫缺陷病毒（HIV）的人有患结核病（TB）的风险。
通过选取1995年6月至1997年6月在华盛顿州西雅图、路易斯安那州新奥尔良和新泽西州泽西城诊断出HIV的1093名基于人群的样本，评估预防结核病的错失机会。
为了确定HIV诊断后接受结核菌素皮肤试验（TST）的人群比例，我们对医疗机构和当地结核病控制部门进行了记录审查。
估计53.7%（95%可信区间49.9 - 57.4）的人在HIV诊断后进行了TST；TST检测患者中有6.6%（95%可信区间4.3 - 8.9%）呈反应性。HIV诊断与TST之间的中位时间为1个月（平均5.7个月，95%可信区间4.8 - 6.5）。与TST相关的因素包括结核病的其他危险因素（比值比1.76，95%可信区间1.17 - 2.63）、HIV相关预防性治疗史（比值比5.84，95%可信区间3.74 - 8.75）、更多的门诊就诊次数（比值比4.16，95%可信区间2.01 - 8.02）以及在有书面政策为所有HIV感染者提供TST的机构就诊（比值比2.54，95%可信区间1.28 - 4.88）。
新诊断出HIV感染的人中约有一半在HIV诊断后进行了TST，不同人口统计学特征的差异不大，这表明普遍需要改进预防结核病的干预措施。
