MMWR Morb Mortal Wkly Rep. 2010 Nov 26;59(46):1509-13.
Worldwide, tuberculosis (TB) incidence increased from 125 cases per 100,000 population in 1990 to 142 cases per 100,000 population in 2004, primarily because of the human immunodeficiency virus (HIV) epidemic. Persons with HIV are at increased risk for TB disease, and those with TB have a high risk for death. This is documented most clearly in resource-limited settings, where limited access to antiretroviral therapy (ART) and other health-care services contribute to the elevated mortality. The impact of HIV on patients with TB is less clear in resource-rich nations such as the United States. To understand the impact of HIV on the risk for death during TB treatment in the United States, data were analyzed for all culture-positive patients with TB from 1993 to 2008, and the proportion that died was determined and stratified by HIV test result. Mortality data were restricted to patients reported before 2007. The proportion of all patients with TB who died during TB treatment decreased from 2,445 of 13,629 (18%) in 1993 to 682 of 7,578 (9%) in 2006. Among patients with TB and HIV, 950 of 2,337 (41%) died during treatment in 1993; this proportion declined to 131 of 663 (20%) in 2006. The proportion of patients with TB and HIV who received their TB diagnosis postmortem dropped from 191 of 2,927 (7%) in 1993 to 32 of 768 (4%) in 2006; 624 of 10,468 (6%) persons with TB and unknown HIV status received their TB diagnosis postmortem in 1993, and this proportion did not decline. Further reductions in mortality can be achieved by enhanced TB/HIV program collaboration and service integration.
全球范围内，1990 年每 10 万人中有 125 例结核病（TB）发病，2004 年上升至每 10 万人中有 142 例，主要是由于人类免疫缺陷病毒（HIV）流行。HIV 感染者患结核病的风险增加，而结核病患者的死亡率也很高。在资源有限的环境中，这一点最为明显，因为抗逆转录病毒疗法（ART）和其他卫生保健服务的获取有限，导致死亡率升高。在资源丰富的国家，如美国，HIV 对结核病患者的影响则不那么明显。为了了解 HIV 对美国结核病治疗期间死亡风险的影响，对 1993 年至 2008 年所有培养阳性的结核病患者的数据进行了分析，并根据 HIV 检测结果确定了死亡比例并进行分层。死亡率数据仅限于 2007 年之前报告的患者。所有结核病患者中，在结核病治疗期间死亡的比例从 1993 年的 13629 例中的 2445 例（18%）下降到 2006 年的 7578 例中的 682 例（9%）。在结核病和 HIV 双重感染患者中，1993 年有 2337 例中的 950 例（41%）在治疗期间死亡；这一比例在 2006 年下降到 663 例中的 131 例（20%）。在结核病和 HIV 双重感染患者中，死后确诊结核病的比例从 1993 年的 2927 例中的 191 例（7%）下降到 2006 年的 768 例中的 32 例（4%）；10468 例结核病和未知 HIV 状况的患者中，624 例在死后确诊结核病，这一比例并未下降。通过加强结核病/艾滋病规划合作和服务整合，可以进一步降低死亡率。
