Mankatittham Wiroj, Likanonsakul Sirirat, Thawornwan Unchana, Kongsanan Paweena, Kittikraisak Wanitchaya, Burapat Channawong, Akksilp Somsak, Sattayawuthipong Wanchai, Srinak Chawin, Nateniyom Sriprapa, Tasaneeyapan Theerawit, Varma Jay K
Bamrasnaradura Infectious Diseases Institute, Nonthaburi, Thailand.
Southeast Asian J Trop Med Public Health. 2009 Jan;40(1):93-103.
To improve understanding about the epidemiology and clinical features of HIV-associated tuberculosis (TB) infection we conducted a prospective, multi-center observational study of HIV-infected TB patients in Thailand. We enrolled HIV-infected patients diagnosed with TB at public health facilities from three provinces and the national infectious diseases referral hospital in Thailand. Patients underwent standardized interviews, evaluations, and laboratory testing at the beginning of TB treatment. We analyzed demographic and clinical characteristics of patients and stratified our findings by level of immune-suppression and whether antiretroviral therapy (ART) was used before TB diagnosis. Of 769 patients analyzed, pulmonary TB was diagnosed in 461 (60%). The median CD4+ T-lymphocyte (CD4) count was 63 cells/microl [interquartile range (IQR), 23-163.5] and the median HIV RNA viral load was 308,000 copies/ml (IQR, 51,900-759,000) at the time of TB diagnosis. Methamphetamine use was reported by 304 patients (40%), marijuana by 267 patients (35%), and injection drug use by 199 patients (26%). Three hundred three patients (40%) reported having been previously incarcerated. Among sexually active patients, 142 (42%) reported never using condoms at all. Patients with CD4 counts <200 cells/microl were significantly more likely than patients with CD4 counts > or =200 cells/microl to have extra-pulmonary TB, fever, fatigue, muscle weakness, no hemoptysis, tachycardia, low body mass index, jaundice, or no pleural effusion. Of the 94 patients that received ART before TB diagnosis, the median time from ART initiation to TB diagnosis was 105 days (IQR, 31-468). HIV-infected patients who developed TB after ART initiation were more likely than other HIV-infected TB patients to have extra-pulmonary TB, a normal chest radiograph, low HIV RNA viral load, or a history of previous TB treatment.
为提高对HIV相关结核病（TB）感染的流行病学和临床特征的认识，我们在泰国开展了一项针对HIV感染的TB患者的前瞻性多中心观察性研究。我们纳入了在泰国三个省份的公共卫生机构以及国家传染病转诊医院被诊断为TB的HIV感染患者。患者在TB治疗开始时接受了标准化访谈、评估和实验室检测。我们分析了患者的人口统计学和临床特征，并根据免疫抑制水平以及在TB诊断之前是否使用抗逆转录病毒疗法（ART）对研究结果进行分层。在分析的769例患者中，461例（60%）被诊断为肺结核。TB诊断时，CD4 + T淋巴细胞（CD4）计数中位数为63个细胞/微升[四分位间距（IQR），23 - 163.5]，HIV RNA病毒载量中位数为308,000拷贝/毫升（IQR，51,900 - 759,000）。304例患者（40%）报告使用过甲基苯丙胺，267例患者（35%）报告使用过大麻，199例患者（26%）报告有注射吸毒史。303例患者（40%）报告曾被监禁。在有性行为的患者中，142例（42%）报告从未使用过避孕套。CD4计数<200个细胞/微升的患者比CD4计数≥200个细胞/微升的患者更有可能出现肺外结核、发热、疲劳、肌肉无力、无咯血、心动过速、低体重指数、黄疸或无胸腔积液。在TB诊断之前接受ART的94例患者中，从开始ART到TB诊断的中位时间为105天（IQR，31 - 468）。在开始ART后发生TB的HIV感染患者比其他HIV感染的TB患者更有可能出现肺外结核、胸部X线片正常、HIV RNA病毒载量低或有既往TB治疗史。
