无症状 HIV 感染成人胸部 X 线异常者筛查结核病预防的结核

Tuberculosis in asymptomatic HIV-infected adults with abnormal chest radiographs screened for tuberculosis prevention.

机构信息

BOTUSA, Gaborone, Botswana.

出版信息

Int J Tuberc Lung Dis. 2010 Jan;14(1):45-51.

PMID:20003694

Abstract

BACKGROUND

Isoniazid preventive therapy (IPT) prevents tuberculosis (TB) in people living with HIV (human immunodeficiency virus, PLWH). Symptom screening without chest radiographs (CXRs) was established as the strategy for excluding TB disease among PLWH seeking IPT in Botswana's 2001 pilot project. This strategy was evaluated in 2004-2006 among candidates screened for an IPT clinical trial.

METHODS

PLWH referred from clinics and HIV testing centers were screened for TB symptoms. All asymptomatic candidates received CXRs; those with abnormal CXRs were investigated further.

RESULTS

Among 2732 asymptomatic candidates screened, 302 (11%) had abnormal CXRs potentially compatible with TB; TB disease was diagnosed in 43 of these 302 (14%), or 43 (1.6%) of the 2732 asymptomatic candidates. While not associated with CD4 lymphocyte counts < 200 cells/mm(3), TB was associated with a positive tuberculin skin test (relative risk 2.1, 95%CI 1.1-4.0). IPT was initiated in 113 (62%) of 182 asymptomatic PLWH with abnormal CXRs; 8/113 (7%) subsequently developed TB, and 7/8 (88%) successfully completed anti-tuberculosis treatment.

CONCLUSIONS

The prevalences of abnormal CXRs and TB were respectively 2.6- and 8.9-fold higher among asymptomatic PLWH screened for the trial than in the pilot. A cost-effectiveness analysis is needed to determine whether the benefits of symptom screening alone are offset by the risk of inducing INH resistance by excluding CXRs during screening.

摘要

背景

异烟肼预防治疗（IPT）可预防人类免疫缺陷病毒（HIV）感染者（PLWH）中的结核病（TB）。2001 年博茨瓦纳试点项目中，建立了不进行胸部 X 线检查（CXR）而仅通过症状筛查来排除寻求 IPT 的 PLWH 中的 TB 疾病的策略。该策略于 2004-2006 年在 IPT 临床试验的候选者中进行了评估。

方法

从诊所和 HIV 检测中心转介的 PLWH 进行 TB 症状筛查。所有无症状的候选人都接受 CXR；CXR 异常者进行进一步调查。

结果

在筛查的 2732 名无症状候选者中，有 302 名（11%）的 CXR 异常，可能与 TB 相符；在这 302 名中，有 43 名（14%）诊断为 TB 病，或在 2732 名无症状候选者中，有 43 名（1.6%）诊断为 TB 病。虽然与 CD4 淋巴细胞计数<200 个细胞/mm(3)无关，但 TB 与结核菌素皮肤试验阳性（相对风险 2.1，95%CI 1.1-4.0）有关。在 182 名 CXR 异常的无症状 PLWH 中，有 113 名（62%）开始 IPT；IPT 后有 8/113（7%）发生 TB，且 7/8（88%）成功完成抗结核治疗。