复发性结核病：复发还是再感染？HIV 在马拉维普通人群队列中的作用。
Recurrent TB: relapse or reinfection? The effect of HIV in a general population cohort in Malawi.
机构信息
Karonga Prevention Study, Chilumba, Malawi.
出版信息
AIDS. 2010 Jan 28;24(3):417-26. doi: 10.1097/QAD.0b013e32832f51cf.
OBJECTIVE
To estimate rates of recurrent tuberculosis due to reinfection and relapse, by HIV status, in a general population.
DESIGN
Long-term cohort study in Karonga district, rural Malawi.
METHODS
All tuberculosis patients with culture-proven disease in Karonga district were followed up after treatment. HIV testing was offered and all Mycobacterium tuberculosis isolates were fingerprinted using IS6110 RFLP. Fingerprints from initial and recurrent disease episodes were compared to distinguish relapse and reinfection: a second episode was considered a relapse if the fingerprint was identical or differed by only 1-4 bands and was the first occurrence of that pattern in the population. Rates of and risk factors for recurrence, reinfection disease, and relapse were estimated using survival analysis and Poisson regression.
RESULTS
Five hundred and eighty-four culture-positive episodes of tuberculosis were diagnosed and treatment was completed during 1995-2003 in patients with known HIV status; 53 culture-positive recurrences occurred by May 2005. Paired fingerprints were available for 39 of these. Reinfections accounted for 1/16 recurrences in HIV-negative and 12/23 in HIV-positive individuals. Rates of relapse were similar in HIV-positive and HIV-negative individuals. Using multiple imputation to allow for missing fingerprint information, the rate of reinfection disease in HIV-positive individuals was 2.2/100 person-years, and in HIV-negative individuals 0.4/100 person-years.
CONCLUSIONS
HIV increases the rate of recurrent tuberculosis in this setting by increasing the rate of reinfection disease, not relapse.
目的
通过 HIV 状况估计普通人群中再感染和复发引起的复发性结核病的发生率。
设计
在马拉维农村卡隆加区进行的长期队列研究。
方法
卡隆加区所有经培养证实患有结核病的患者在治疗后均进行随访。提供 HIV 检测，并用 IS6110 RFLP 对所有结核分枝杆菌分离株进行指纹图谱分析。比较初始和复发病例的指纹图谱以区分复发和再感染：如果指纹图谱完全相同或仅相差 1-4 条带且为人群中该模式的首次出现，则第二个病例被认为是复发。使用生存分析和泊松回归估计复发、再感染疾病和复发的发生率和危险因素。
结果
1995-2003 年期间，在已知 HIV 状况的患者中诊断出 584 例培养阳性的结核病病例，治疗完成；截至 2005 年 5 月，发生了 53 例培养阳性的复发病例。其中 39 例可获得配对指纹图谱。在 HIV 阴性患者中，有 1/16 的复发是再感染，而在 HIV 阳性患者中，有 12/23 的复发是再感染。HIV 阳性和 HIV 阴性个体的复发率相似。使用多重插补来允许缺失指纹信息，HIV 阳性个体的再感染疾病发生率为 2.2/100 人年，而 HIV 阴性个体为 0.4/100 人年。
结论
在这种情况下，HIV 通过增加再感染疾病的发生率而不是复发率来增加复发性结核病的发生率。
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