Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
PLoS One. 2011 May 12;6(5):e19484. doi: 10.1371/journal.pone.0019484.
In the developing world, the principal cause of death among HIV-infected patients is tuberculosis (TB). The initiation of antiretroviral therapy (ART) during TB therapy significantly improves survival, however it is not known which barriers prevent eligible TB patients from initiating life-saving ART.
Setting. A South African township clinic with integrated tuberculosis and HIV services. Design. Logistic regression analyses of a prospective cohort of HIV-1 infected adults (≥18 years) who commenced TB therapy, were eligible for ART, and were followed for 6 months.
Of 100 HIV-1 infected adults eligible for ART during TB therapy, 90 TB patients presented to an ART clinic for assessment, 66 TB patients initiated ART, and 15 TB patients died. 34% of eligible TB patients (95%CI: 25-43%) did not initiate ART. Male gender and younger age (<36 years) were associated with failure to initiate ART (adjusted odds ratios of 3.7 [95%CI: 1.25-10.95] and 3.3 [95%CI: 1.12-9.69], respectively). Death during TB therapy was associated with a CD4+ count <100 cells/µL.
In a clinic with integrated services for tuberculosis and HIV, one-third of eligible TB patients--particularly young men--did not initiate ART. Strategies are needed to promote ART initiation during TB therapy, especially among young men.
在发展中国家，HIV 感染者的主要死因是结核病（TB）。在结核病治疗期间开始抗逆转录病毒治疗（ART）可显著提高生存率，但尚不清楚哪些障碍阻止了符合条件的结核病患者开始进行拯救生命的 ART。
在一家南非乡镇诊所进行，该诊所提供结核病和 HIV 综合服务。设计：对开始结核病治疗、有资格接受 ART 且随访 6 个月的 HIV-1 感染成人（≥18 岁）前瞻性队列进行逻辑回归分析。
在 100 名在结核病治疗期间有资格接受 ART 的 HIV-1 感染成人中，有 90 名结核病患者到 ART 诊所接受评估，有 66 名结核病患者开始接受 ART，有 15 名结核病患者死亡。有 34%（95%CI：25-43%）符合条件的结核病患者未开始 ART。男性和年龄较小（<36 岁）与未能开始 ART 相关（调整后的优势比分别为 3.7[95%CI：1.25-10.95]和 3.3[95%CI：1.12-9.69]）。结核病治疗期间死亡与 CD4+计数<100 个细胞/µL 相关。
在一个提供结核病和 HIV 综合服务的诊所中，有三分之一的符合条件的结核病患者——特别是年轻男性——未开始接受 ART。需要采取策略来促进结核病治疗期间开始接受 ART，尤其是在年轻男性中。
