HIV/AIDS Outpatient Clinic, Clinicas Hospital, School of Medicine, São Paulo University, São Paulo, Brazil.
HIV Med. 2009 Oct;10(9):564-72. doi: 10.1111/j.1468-1293.2009.00730.x.
Tuberculosis (TB) remains an important disease associated with HIV infection and AIDS in Brazil, even in a setting of free access to antiretroviral therapy (ART) and TB treatment. In previous studies, isoniazid therapy (IT) for latent infection with Mycobacterium tuberculosis (LIMTb) was found to reduce the risk of TB by 62% in patients with a tuberculin test (TT)>5 mm. The objectives of this study were to investigate the occurrence of TB, the prevalence of LIMTb and the coverage of the TT and IT, and to estimate the number of missed opportunities to prevent TB in patients with HIV/AIDS.
A random sample of patients with HIV/AIDS was selected; data from the medical files were obtained, and a TT was performed in consenting subjects.
In the 203 subjects included in the study, TB occurrence was 13.3%, LIMTb prevalence was 20% and the coverage of the TT and IT was 59.2 and 55%, respectively. Patients with TB had a lower nadir CD4 cell count, but their CD4 recovery was comparable to that of non-TB patients. Patients with LIMTb always had a higher CD4 cell count.
By expanding the coverage of the TT and IT to nearly 100%, we could more than double the number of prevented cases of TB. TB prevention programmes must be reinforced to reduce the number of missed opportunities for diagnosis, and IT must be improved to reduce TB among patients with HIV/AIDS. Empowering patients with knowledge about TB, the preventive role of IT and the need for an annual TT may be the best way of lowing rates of TB in patients with HIV/AIDS.
结核病（TB）仍然是巴西与 HIV 感染和艾滋病相关的重要疾病，即使在免费获得抗逆转录病毒治疗（ART）和结核病治疗的情况下也是如此。在以前的研究中，发现异烟肼治疗（IT）潜伏性结核分枝杆菌（LIMTb）可使结核菌素试验（TT）>5 毫米的患者发生结核病的风险降低 62%。本研究的目的是调查结核病的发生、LIMTb 的流行率以及 TT 和 IT 的覆盖率，并估计在 HIV/AIDS 患者中预防结核病的机会错失数量。
选择 HIV/AIDS 患者的随机样本；从病历中获取数据，并在同意的受试者中进行 TT。
在纳入研究的 203 名患者中，结核病的发生率为 13.3%，LIMTb 的患病率为 20%，TT 和 IT 的覆盖率分别为 59.2%和 55%。患有结核病的患者的 CD4 细胞计数最低值较低，但他们的 CD4 恢复与非结核病患者相当。患有 LMTb 的患者的 CD4 细胞计数总是较高。
通过将 TT 和 IT 的覆盖率扩大到近 100%，我们可以使预防结核病的病例数增加一倍以上。必须加强结核病预防计划，以减少诊断机会的错失，并改善 IT，以减少 HIV/AIDS 患者中的结核病。让患者了解结核病、IT 的预防作用以及每年进行 TT 的必要性，可能是降低 HIV/AIDS 患者结核病发病率的最佳方法。
