New York City Department of Health and Mental Hygiene, New York, New York 10007, USA.
Int J Tuberc Lung Dis. 2010 Dec;14(12):1613-20.
To review outcomes of human immunodeficiency virus (HIV) positive tuberculosis (TB) patients in New York City (NYC) to determine if the World Health Organization treatment success target of 85% was met in a setting with ready access to treatment for HIV and TB.
Retrospective review of new TB patients diagnosed from 1995 to 2004, excluding patients with rifampin (RMP) resistance.
Of 9198 eligible TB patients, 83% had achieved treatment success, 8% died during treatment, 4% failed, 3% defaulted and 2% were transferred from NYC. Among 6374 HIV-negative individuals, treatment success was consistently over 85%; 5% died during treatment. Among 2824 HIV-positive individuals, treatment success was 72% overall and 66% in sputum acid-fast bacilli smear-positive patients. Mortality among the HIV-positive decreased from 26% in 1995 to 14% in 2004. HIV-positive patients achieved higher treatment success if 1) they received treatment by directly observed therapy (DOT) (82% vs. 74%, OR(adj) = 1.80, 95%CI 1.44-2.26), or 2) were administered rifabutin (RFB) in the regimen, a proxy for receiving antiretroviral therapy (ART) (84% vs. 78%, OR(adj) = 1.49, 95%CI 1.20-1.85). Treatment success of 85% was achieved in HIV-positive patients who received RFB and DOT.
High mortality precluded achieving 85% treatment success among HIV-positive TB patients. DOT and ART remain essential for improving success among co-infected patients everywhere.
回顾纽约市（NYC）人类免疫缺陷病毒（HIV）阳性结核病（TB）患者的结局，以确定在HIV 和 TB 治疗机会充足的情况下，世界卫生组织（WHO）规定的 85%治疗成功率目标是否达到。
对 1995 年至 2004 年间新诊断的 TB 患者进行回顾性分析，排除耐利福平（RMP）的患者。
在 9198 名符合条件的 TB 患者中，83%达到了治疗成功，8%在治疗期间死亡，4%失败，3%失访，2%从 NYC 转移。在 6374 名 HIV 阴性个体中，治疗成功率始终超过 85%；5%在治疗期间死亡。在 2824 名 HIV 阳性个体中，总体治疗成功率为 72%，痰涂片阳性患者为 66%。HIV 阳性患者的死亡率从 1995 年的 26%降至 2004 年的 14%。如果 1）接受直接观察治疗（DOT）治疗（82%比 74%，调整后 OR（adj）=1.80，95%CI 1.44-2.26），或 2）接受利福布丁（RFB）治疗方案，这是接受抗逆转录病毒治疗（ART）的替代指标，HIV 阳性患者的治疗成功率更高（84%比 78%，调整后 OR（adj）=1.49，95%CI 1.20-1.85）。接受 RFB 和 DOT 的 HIV 阳性患者达到了 85%的治疗成功率。
高死亡率使得 HIV 阳性 TB 患者无法达到 85%的治疗成功率。DOT 和 ART 仍然是提高合并感染患者成功率的关键。
