1992-2005 年期间，纽约市感染 HIV 的结核病患的社会人口学和临床特征变化。

Changing sociodemographic and clinical characteristics of tuberculosis among HIV-infected patients, New York City, 1992-2005.

机构信息

New York City Department of Health and Mental Hygiene, New York, New York, USA.

出版信息

Clin Infect Dis. 2010 Jun 1;50(11):1524-31. doi: 10.1086/652654.

DOI:10.1086/652654

PMID:20415570

Abstract

BACKGROUND

Although highly active antiretroviral therapy (HAART) has decreased human immunodeficiency virus (HIV)-related morbidity, tuberculosis remains an important disease among HIV-infected individuals.

METHODS

By use of surveillance data, sociodemographic and clinical changes among HIV-infected and HIV-uninfected tuberculosis patients in New York City were evaluated using the Cochran-Armitage trend test and multivariate logistic regression across 3 periods: 1992-1995 (pre-HAART), 1996-2000 (early HAART), and 2001-2005 (late HAART).

RESULTS

Among tuberculosis patients with known HIV status, 4345 (60%) of 7224 were HIV-infected in pre-HAART, 1943 (33%) of 5933 in early HAART, and 851 (22%) of 3815 in late HAART (P < .001 for trend). During the study period, the age of HIV-infected tuberculosis patients increased, and greater proportions were female, non-Hispanic black, Asian, and foreign born; the proportion that was non-Hispanic white decreased. The proportion that was culture-negative for Mycobacterium tuberculosis increased (from 7% pre-HAART to 21% late HAART; P < .001 for trend; early HAART vs pre-HAART adjusted odds ratio [aOR], 1.68; 95% confidence interval [CI], 1.38-2.04), and the proportion with extrapulmonary disease also increased (from 32% to 46%; P < .001 for trend). The proportion with multidrug-resistant tuberculosis decreased (from 16% to 4%; P < .001 for trend), especially from pre-HAART to early HAART (aOR, 0.31; 95% CI, 0.25-0.40). The proportion who died before tuberculosis treatment decreased (from 12% to 7%), and the proportion who died during tuberculosis treatment also decreased (from 29% to 11%) (both, P < .001 for trend). Over time, HIV-infected tuberculosis patients had AIDS longer before the diagnosis of tuberculosis (P < .001 for trend). Similar trends for culture, site of disease, and drug resistance were seen for HIV-uninfected tuberculosis patients.

CONCLUSIONS

The sociodemographic and clinical characteristics changed substantially among HIV-infected tuberculosis patients in New York City. Awareness of these changes may speed diagnosis of tuberculosis. Future studies should evaluate HAART's effect on tuberculosis presentation among HIV-infected patients.

摘要

背景

尽管高效抗逆转录病毒疗法（HAART）降低了与人类免疫缺陷病毒（HIV）相关的发病率，但结核病仍然是 HIV 感染者中的重要疾病。

方法

利用监测数据，通过 Cochran-Armitage 趋势检验和多变量逻辑回归，评估了纽约市 HIV 感染者和 HIV 未感染者结核病患者在三个时期（1992-1995 年[HAART 前]、1996-2000 年[早期 HAART]和 2001-2005 年[晚期 HAART]）的变化。

结果

在已知 HIV 状态的结核病患者中，4345 例（60%）在 HAART 前感染 HIV，5933 例（33%）在早期 HAART 时感染 HIV，3815 例（22%）在晚期 HAART 时感染 HIV（趋势检验 P<0.001）。在研究期间，HIV 感染者结核病患者的年龄增大，女性、非西班牙裔黑人、亚洲人和外国出生的比例增加，非西班牙裔白人的比例下降。结核分枝杆菌培养阴性的比例增加（从 HAART 前的 7%增加到晚期 HAART 的 21%；趋势检验 P<0.001；早期 HAART 与 HAART 前校正比值比[aOR]，1.68；95%置信区间[CI]，1.38-2.04），肺外疾病的比例也增加（从 32%增加到 46%；趋势检验 P<0.001）。耐多药结核病的比例下降（从 16%下降到 4%；趋势检验 P<0.001），尤其是从 HAART 前到早期 HAART（aOR，0.31；95%CI，0.25-0.40）。在结核病治疗前死亡的比例下降（从 12%下降到 7%），在结核病治疗期间死亡的比例也下降（从 29%下降到 11%）（均趋势检验 P<0.001）。随着时间的推移，HIV 感染者结核病患者在诊断结核病前 AIDS 的持续时间更长（趋势检验 P<0.001）。HIV 未感染者结核病患者也有类似的培养、病变部位和耐药趋势。