Moore David, Liechty Cheryl, Ekwaru Paul, Were Willy, Mwima Gerald, Solberg Peter, Rutherford George, Mermin Jonathan
Global AIDS Program, US Centers for Disease Control and Prevention (CDC), Entebbe, Uganda.
AIDS. 2007 Mar 30;21(6):713-9. doi: 10.1097/QAD.0b013e328013f632.
Tuberculosis (TB) is the leading cause of death among people with HIV in sub-Saharan Africa. Expanding access to antiretroviral therapy (ART) may reduce the burden of TB, but to what extent is unknown.
In a study of 1044 adults who initiated home-based ART in Tororo, Uganda between 1 May 2003 and 30 June 2005, participants were screened for active TB at baseline and then monitored at weekly home visits. Participants with TB at baseline or follow-up were compared with those without TB to determine factors associated with mortality in those with TB.
At baseline, 75 (7.2%) subjects had TB and a total of 53 (5.5%) were diagnosed with TB over a median of 1.4 years of follow-up (3.90 cases/100 person years). Cumulative mortality was 17.9/100 person-years for those with TB and 3.8/100 person-years for those without TB (P < 0.001). Mortality was associated with low baseline CD4 cell counts [relative hazard (RH), 0.99 per 1 cell/microl increase; P = 0.03] and marginally associated with a body mass index <or= 18 (RH, 2.04; P = 0.10) and increasing age (RH, 1.04 per year; P = 0.11). TB incidence and TB-associated mortality were highest within the first 6 months of ART and declined to 52% and 61% of expected values, respectively, from months 7 to 18 after ART initiation.
TB remains an important cause of illness and death in patients receiving ART in Uganda. However, both appear to decline markedly, after 6 months of ART.
在撒哈拉以南非洲地区，结核病是艾滋病毒感染者的主要死因。扩大抗逆转录病毒治疗（ART）的可及性可能会减轻结核病负担，但具体程度尚不清楚。
在一项针对2003年5月1日至2005年6月30日期间在乌干达托罗罗开始接受家庭ART治疗的1044名成年人的研究中，参与者在基线时接受活动性结核病筛查，然后在每周的家访中进行监测。将基线或随访时患有结核病的参与者与未患结核病的参与者进行比较，以确定结核病患者死亡的相关因素。
基线时，75名（7.2%）受试者患有结核病，在中位1.4年的随访期内，共有53名（5.5%）被诊断为结核病（3.90例/100人年）。结核病患者的累积死亡率为17.9/100人年，未患结核病患者为3.8/100人年（P<0.001）。死亡率与基线CD4细胞计数低相关[相对危险度（RH），每增加1个细胞/微升为0.99；P = 0.03]，与体重指数≤18略相关（RH，2.04；P = 0.10）以及年龄增长相关（RH，每年1.04；P = 0.11）。结核病发病率和结核病相关死亡率在ART治疗的前6个月内最高，在开始ART治疗后的第7至18个月分别降至预期值的52%和61%。
在乌干达接受ART治疗的患者中，结核病仍然是疾病和死亡的重要原因。然而，在ART治疗6个月后，两者似乎都显著下降。
