HIV 感染和未感染结核患者的高复发率。

High rates of recurrence in HIV-infected and HIV-uninfected patients with tuberculosis.

机构信息

Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom.

出版信息

J Infect Dis. 2010 Mar;201(5):704-11. doi: 10.1086/650529.

DOI:10.1086/650529

PMID:20121434

Abstract

BACKGROUND

The rate of recurrent tuberculosis disease due to reinfection, compared with the incidence of new tuberculosis, in those with and without HIV infection is not known.

METHODS

In a retrospective cohort study of South African gold miners, men with known dates of seroconversion to HIV (from 1991 to 1997) and HIV-negative men were followed up to 2004. Rates of tuberculosis recurrence >2 years after the first episode were used as a proxy for reinfection disease rates.

RESULTS

Among 342 HIV-positive and 321 HIV-negative men who had had 1 previous episode of tuberculosis, rates of recurrence were 19.7 cases per 100 person-years at risk (PYAR; 95% confidence interval [CI], 16.4-23.7) and 7.7 cases per 100 PYAR (95% CI, 6.1-9.8), respectively. The recurrence rate did not vary by duration of HIV infection. Recurrent pulmonary tuberculosis rates >2 years after the first episode were 24.4 cases per 100 PYAR (95% CI, 17.2-34.8) in HIV-positive men and 4.3 cases per 100 PYAR (95% CI, 2.2-8.3) in HIV-negative men, compared with incidence rates of new pulmonary tuberculosis of 3.7 cases per 100 PYAR (95% CI, 3.3-4.1) in HIV-positive men and 0.75 cases per 100 PYAR (95% CI, 0.67-0.84) in HIV-negative men in the same cohort.

CONCLUSIONS

Tuberculosis recurrence rates, likely due to reinfection, were much higher than incidence rates. The findings suggest heterogeneity in susceptibility, implying that a vaccine could still provide useful protection in the population and strengthening the case for secondary preventive therapy.

摘要

背景

在有和没有 HIV 感染的人群中，因再感染导致的复发性结核病的发病率与新发病例的发病率相比尚不清楚。

方法

在一项对南非金矿工人的回顾性队列研究中，对已知 HIV 血清转换日期（1991 年至 1997 年）的男性和 HIV 阴性男性进行了随访，随访至 2004 年。将首次发作后 2 年以上的结核病复发率作为再感染疾病率的替代指标。

结果

在 342 例 HIV 阳性和 321 例 HIV 阴性的曾有过 1 次结核病发作的男性中，复发率分别为每 100 人年风险（PYAR）19.7 例（95%置信区间[CI]，16.4-23.7）和 7.7 例（95%CI，6.1-9.8）。复发率与 HIV 感染的持续时间无关。首次发作后 2 年以上的复发性肺结核的发病率分别为 HIV 阳性男性每 100 PYAR 24.4 例（95%CI，17.2-34.8）和 HIV 阴性男性每 100 PYAR 4.3 例（95%CI，2.2-8.3），而在同一队列中，HIV 阳性男性新发性肺结核的发病率为每 100 PYAR 3.7 例（95%CI，3.3-4.1），HIV 阴性男性的发病率为每 100 PYAR 0.75 例（95%CI，0.67-0.84）。