Srikantiah P, Lin R, Walusimbi M, Okwera A, Luzze H, Whalen C C, Boom W H, Havlir D V, Charlebois E D
Division of HIV/AIDS, San Francisco General Hospital, University of California, San Francisco 94110, USA.
Int J Tuberc Lung Dis. 2007 Feb;11(2):168-74.
Voluntary counseling and testing (VCT) for the human immunodeficiency virus (HIV) is recommended for persons treated for tuberculosis (TB). Opportunities to diagnose HIV may be missed by limiting HIV testing to only persons diagnosed with TB. Among TB suspects in Uganda, we determined HIV prevalence, risk behaviors, and willingness to refer family for VCT.
Consenting adult patients presenting for evaluation at a referral TB clinic received same-day VCT. TB diagnosis data were abstracted from clinical records.
Among 665 eligible patients, 565 (85%) consented to VCT. Among these, 238 (42%) were HIV-positive. Of the HIV-infected patients, 37% had received a non-TB diagnosis. HIV seroprevalence was higher in patients with a non-TB diagnosis (49%) than those diagnosed with TB (39%) (P = 0.02). Fewer than 6% of HIV-infected patients reported always using condoms with sexual partners. The majority of patients (86%) reported being 'very willing' to refer family members for VCT.
Over 35% of HIV-infected cases in our population would have been undetected if HIV testing was limited to cases with diagnosed TB. The high HIV seroprevalence in both TB and non-TB cases merits HIV testing for all patients evaluated at TB clinics. HIV-infected TB suspects reporting high-risk behavior are at risk for HIV transmission, and should receive risk-reduction counseling.
建议对接受结核病（TB）治疗的人群进行人类免疫缺陷病毒（HIV）自愿咨询和检测（VCT）。仅对已确诊结核病的人群进行HIV检测可能会错过诊断HIV的机会。在乌干达的结核病疑似患者中，我们确定了HIV感染率、风险行为以及将家人转介进行VCT的意愿。
在一家结核病转诊诊所就诊并同意参与的成年患者接受了当日VCT。结核病诊断数据从临床记录中提取。
在665名符合条件的患者中，565名（85%）同意进行VCT。其中，238名（42%）为HIV阳性。在HIV感染患者中，37%曾被诊断为非结核病。非结核病诊断患者的HIV血清阳性率（49%）高于结核病诊断患者（39%）（P = 0.02）。不到6%的HIV感染患者报告总是与性伴侣使用避孕套。大多数患者（86%）报告“非常愿意”将家庭成员转介进行VCT。
如果HIV检测仅限于已确诊结核病的病例，我们研究人群中超过35%的HIV感染病例将无法被检测到。结核病和非结核病病例中HIV血清阳性率都很高，这意味着应对在结核病诊所接受评估的所有患者进行HIV检测。报告有高风险行为的HIV感染结核病疑似患者存在HIV传播风险，应接受降低风险咨询。
