South African Centre for Epidemiological Modelling and Analysis, Stellenbosch 7600, South Africa.
Proc Natl Acad Sci U S A. 2010 Nov 9;107(45):19485-9. doi: 10.1073/pnas.1005660107. Epub 2010 Oct 25.
HIV has increased the incidence of tuberculosis (TB) by up to sevenfold in African countries, but antiretroviral therapy (ART) reduces the incidence of AIDS-related TB. We use a mathematical model to investigate the short-term and long-term impacts of ART on the incidence of TB, assuming that people are tested for HIV once a year, on average, and start ART at a fixed time after HIV seroconversion or at a fixed CD4(+) cell count. We fit the model to trend data on HIV prevalence and TB incidence in nine countries in sub-Saharan Africa. If HIV-positive people start ART within 5 y of seroconversion, the incidence of AIDS-related TB in 2015 will be reduced by 48% (range: 37-55%). Long-term reductions depend sensitively on the delay to starting ART. If treatment is started 5, 2, or 1 y after HIV seroconversion, or as soon as people test positive, the incidence in 2050 will be reduced by 66% (range: 57-80%), 95% (range: 93-96%), 97.7% (range: 96.9-98.2%) and 98.4% (range: 97.8-98.9%), respectively. In the countries considered here, early ART could avert 0.71 ± 0.36 [95% confidence interval (CI)] million of 3.4 million cases of TB between 2010 and 2015 and 5.8 ± 2.9 (95% CI) million of 15 million cases between 2015 and 2050. As more countries provide ART at higher CD4(+) cell counts, the impact on TB should be investigated to test the predictions of this model.
HIV 使非洲国家的结核病（TB）发病率增加了多达七倍，但抗逆转录病毒疗法（ART）降低了艾滋病相关 TB 的发病率。我们使用一个数学模型来研究 ART 对 TB 发病率的短期和长期影响，假设人们每年平均接受一次 HIV 检测，并在 HIV 血清转换后固定时间或固定 CD4（+）细胞计数开始接受 ART。我们将该模型拟合到撒哈拉以南非洲九个国家的 HIV 流行率和 TB 发病率趋势数据上。如果 HIV 阳性者在血清转换后 5 年内开始接受 ART，那么 2015 年艾滋病相关 TB 的发病率将降低 48%（范围：37-55%）。长期减少取决于开始接受 ART 的延迟。如果在 HIV 血清转换后 5、2 或 1 年开始治疗，或者一旦检测到阳性就开始治疗，那么到 2050 年，发病率将降低 66%（范围：57-80%）、95%（范围：93-96%）、97.7%（范围：96.9-98.2%）和 98.4%（范围：97.8-98.9%）。在考虑的这些国家中，早期 ART 可以避免 2010 年至 2015 年间 3400 万例结核病病例中的 0.71±0.36 百万例（95%置信区间[CI]）和 2015 年至 2050 年间 1500 万例结核病病例中的 5.8±2.9 百万例（95%CI）。随着更多国家以更高的 CD4（+）细胞计数提供 ART，应该调查其对 TB 的影响，以检验该模型的预测。
