The University of North Carolina at Chapel Hill, Department of Epidemiology, Chapel Hill, NC, USA.
Int J Epidemiol. 2009 Dec;38(6):1612-21. doi: 10.1093/ije/dyp208. Epub 2009 May 15.
We aimed to estimate the effect of anti-retroviral therapy (ART) on incident tuberculosis (TB) in a cohort of HIV-infected children.
We analysed data from ART-naïve, TB disease-free children enrolled between December 2004 and April 2008 into an HIV care program in Kinshasa, Democratic Republic of Congo. To estimate the effect of ART on TB incidence while accounting for time-dependent confounders affected by exposure, a Cox proportional hazards marginal structural model was used.
364 children contributed 596.0 person-years of follow-up. At baseline, the median age was 6.9 years; 163 (44.8%) were in HIV clinical stage 3 or 4. During follow-up, 242 (66.5%) children initiated ART and 81 (22.3%) developed TB. At TB diagnosis, 41 (50.6%) were receiving ART. The TB incidence rate in those receiving ART was 10.2 per 100 person-years [95% confidence interval (CI) 7.4-13.9] compared with 20.4 per 100 person-years (95% CI 14.6-27.8) in those receiving only primary HIV care. TB incidence decreased with time on ART, from 18.9 per 100 person-years in the first 6 months to 5.3 per 100 person-years after 12 months of ART. The model-estimated TB hazard ratio for ART was 0.51 (95% CI 0.27-0.94).
For HIV-infected children in TB-endemic areas, ART reduces the hazard of developing TB by 50%.
我们旨在评估抗逆转录病毒疗法（ART）对 HIV 感染儿童中结核病（TB）发病的影响。
我们分析了 2004 年 12 月至 2008 年 4 月期间在刚果民主共和国金沙萨的一项 HIV 护理项目中入组的、无 ART 治疗史和无 TB 病史的 HIV 感染儿童的数据。为了在考虑到因暴露而导致的时间依赖性混杂因素的情况下估计 ART 对 TB 发病率的影响，我们使用了 Cox 比例风险边际结构模型。
364 名儿童共提供了 596.0 人年的随访数据。基线时，中位年龄为 6.9 岁；163 名（44.8%）儿童处于 HIV 临床分期 3 或 4 期。在随访期间，242 名（66.5%）儿童开始接受 ART，81 名（22.3%）发展为 TB。在 TB 诊断时，41 名（50.6%）正在接受 ART。正在接受 ART 的儿童的 TB 发病率为 10.2/100 人年[95%置信区间（CI）7.4-13.9]，而仅接受初级 HIV 护理的儿童的 TB 发病率为 20.4/100 人年（95% CI 14.6-27.8）。随着 ART 时间的延长，TB 发病率逐渐降低，从第 1 至 6 个月的 18.9/100 人年降至第 12 个月后的 5.3/100 人年。模型估计的 ART 对 TB 的危害比为 0.51（95% CI 0.27-0.94）。
在结核病流行地区的 HIV 感染儿童中，ART 可使发生 TB 的风险降低 50%。
