中低收入国家 HIV 规划中的结核病：实践和风险因素。
Tuberculosis in HIV programmes in lower-income countries: practices and risk factors.
机构信息
Institute of Social and Preventive Medicine, Berne, Switzerland.
出版信息
Int J Tuberc Lung Dis. 2011 May;15(5):620-7. doi: 10.5588/ijtld.10.0249.
BACKGROUND
Tuberculosis (TB) is a common diagnosis in human immunodeficiency virus (HIV) infected patients on antiretroviral treatment (ART).
OBJECTIVE
To describe TB-related practices in ART programmes in lower-income countries and identify risk factors for TB in the first year of ART.
METHODS
Programme characteristics were assessed using standardised electronic questionnaire. Patient data from 2003 to 2008 were analysed and incidence rate ratios (IRRs) calculated using Poisson regression models.
RESULTS
Fifteen ART programmes in 12 countries in Africa, South America and Asia were included. Chest X-ray, sputum microscopy and culture were available free of charge in respectively 13 (86.7%), 14 (93.3%) and eight (53.3%) programmes. Eight sites (53.3%) used directly observed treatment and five (33.3%) routinely administered isoniazid preventive treatment (IPT). A total of 19 413 patients aged ≥ 16 years contributed 13,227 person-years of follow-up; 1081 new TB events were diagnosed. Risk factors included CD4 cell count (>350 cells/μl vs. <25 cells/μl, adjusted IRR 0.46, 95%CI 0.33-0.64, P < 0.0001), sex (women vs. men, adjusted IRR 0.77, 95%CI 0.68-0.88, P = 0.0001) and use of IPT (IRR 0.24, 95%CI 0.19-0.31, P < 0.0001).
CONCLUSIONS
Diagnostic capacity and practices vary widely across ART programmes. IPT prevented TB, but was used in few programmes. More efforts are needed to reduce the burden of TB in HIV co-infected patients in lower income countries.
背景
在接受抗逆转录病毒治疗（ART）的人类免疫缺陷病毒（HIV）感染患者中，结核病（TB）是常见的诊断。
目的
描述低收入国家 ART 项目中与结核病相关的实践，并确定 ART 治疗第一年发生结核病的风险因素。
方法
使用标准化电子问卷评估项目特征。分析了 2003 年至 2008 年的患者数据，并使用泊松回归模型计算发病率比（IRR）。
结果
纳入了来自非洲、南美洲和亚洲 12 个国家的 15 个 ART 项目。13 个（86.7%）、14 个（93.3%）和 8 个（53.3%）项目可免费提供胸部 X 光、痰显微镜检查和培养。8 个（53.3%）地点使用直接观察治疗，5 个（33.3%）常规给予异烟肼预防性治疗（IPT）。共有 19413 名年龄≥16 岁的患者，随访 13227 人年；诊断出 1081 例新的结核病事件。风险因素包括 CD4 细胞计数（>350 个细胞/μl 与<25 个细胞/μl，调整后的 IRR 0.46，95%CI 0.33-0.64，P<0.0001）、性别（女性与男性，调整后的 IRR 0.77，95%CI 0.68-0.88，P=0.0001）和 IPT 的使用（IRR 0.24，95%CI 0.19-0.31，P<0.0001）。
结论
ART 项目中的诊断能力和实践差异很大。IPT 预防了结核病，但在少数项目中使用。需要做出更多努力来降低低收入国家 HIV 合并感染患者结核病的负担。
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