旧金山无家可归者中结核病病例和 HIV+接触者的进化同步的实证证据。

Empirical evidence for synchrony in the evolution of TB cases and HIV+ contacts among the San Francisco homeless.

机构信息

MITRE Corporation, McLean, Virginia, USA.

出版信息

PLoS One. 2010 Jan 22;5(1):e8851. doi: 10.1371/journal.pone.0008851.

Abstract

The re-emergence of tuberculosis (TB) in the mid-1980s in many parts of the world, including the United States, is often attributed to the emergence and rapid spread of human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). Although it is well established that TB transmission is particularly amplified in populations with high HIV prevalence, the epidemiology of interaction between TB and HIV is not well understood. This is partly due to the scarcity of HIV-related data, a consequence of the voluntary nature of HIV status reporting and testing, and partly due to current practices of screening high risk populations through separate surveillance programs for HIV and TB. The San Francisco Department of Public Health, TB Control Program, has been conducting active surveillance among the San Francisco high-risk populations since the early 1990s. We present extensive TB surveillance data on HIV and TB infection among the San Francisco homeless to investigate the association between the TB cases and their HIV+ contacts. We applied wavelet coherence and phase analyses to the TB surveillance data from January 1993 through December 2005, to establish and quantify statistical association and synchrony in the highly non-stationary and ostensibly non-periodic waves of TB cases and their HIV+ contacts in San Francisco. When stratified by homelessness, we found that the evolution of TB cases and their HIV+ contacts is highly coherent over time and locked in phase at a specific periodic scale among the San Francisco homeless, but no significant association was observed for the non-homeless. This study confirms the hypothesis that the dynamics of HIV and TB are significantly intertwined and that HIV is likely a key factor in the sustenance of TB transmission among the San Francisco homeless. The findings of this study underscore the importance of contact tracing in detection of HIV+ individuals that may otherwise remain undetected, and thus highlights the ever-increasing need for HIV-related data and an integrative approach to monitoring high-risk populations with respect to HIV and TB transmission.

摘要

结核病(TB)在 20 世纪 80 年代中期在世界许多地区(包括美国)的再次出现,通常归因于人类免疫缺陷病毒(HIV)和获得性免疫缺陷综合征(AIDS)的出现和迅速传播。尽管已经确定 TB 传播在 HIV 流行率高的人群中特别放大,但 TB 和 HIV 之间相互作用的流行病学尚不完全清楚。这部分是由于缺乏与 HIV 相关的数据,这是由于 HIV 状况报告和检测的自愿性质造成的,部分原因是由于目前通过单独的 HIV 和 TB 监测计划筛选高危人群的做法。旧金山公共卫生部结核病控制计划自 20 世纪 90 年代初以来一直在对旧金山高危人群进行积极监测。我们提供了旧金山无家可归者中 HIV 和 TB 感染的广泛 TB 监测数据,以调查 TB 病例与其 HIV+接触者之间的关联。我们应用小波相干和相位分析方法对 1993 年 1 月至 2005 年 12 月的 TB 监测数据进行了分析,以确定和量化旧金山 TB 病例及其 HIV+接触者的高度非平稳和明显非周期性波之间的统计关联和同步性。按无家可归状况分层时,我们发现 TB 病例及其 HIV+接触者的演变在时间上具有高度的相干性,并且在旧金山无家可归者中锁定在特定的周期性尺度上,但在非无家可归者中未观察到显著关联。这项研究证实了 HIV 和 TB 的动态紧密交织的假设,并且 HIV 很可能是维持旧金山无家可归者中 TB 传播的关键因素。这项研究的结果强调了接触者追踪在发现否则可能未被发现的 HIV+个体方面的重要性,因此突出了对 HIV 相关数据和监测 HIV 和 TB 传播高危人群的综合方法的日益增长的需求。

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