Central TB Division, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India, New Delhi, India.
PLoS One. 2011;6(9):e24297. doi: 10.1371/journal.pone.0024297. Epub 2011 Sep 8.
In 2010, WHO expanded previously-recommended indications for anti-retroviral treatment to include all HIV-infected TB patients irrespective of CD4 count. India, however, still limits ART to those TB patients with CD4 counts <350/mm(3) or with extrapulmonary TB manifestations. We sought to evaluate the additional number of patients that would be initiated on ART if India adopted the current 2010 WHO ART guidelines for HIV-infected TB patients.
We evaluated all TB patients recorded in treatment registers of the Revised National TB Control Programme in June 2010 in the high-HIV prevalence state of Karnataka, and cross-matched HIV-infected TB patients with ART programme records.
Of 6182 TB patients registered, HIV status was ascertained for 5761(93%) and 710(12%) were HIV-infected. 146(21%) HIV-infected TB patients were on ART prior to TB diagnosis. Of the remaining 564, 497(88%) were assessed for ART eligibility; of these, 436(88%) were eligible for ART according to 2006 WHO ART guidelines. Altogether, 487(69%) HIV-infected TB patients received ART during TB treatment. About 80% started ART within 8 weeks of TB treatment and 95% received an efavirenz based regimen.
In Karnataka, India, about nine out of ten HIV-infected TB patients were eligible for ART according to 2006 WHO ART guidelines. The efficiency of HIV case finding, ART evaluation, and ART initiation was relatively high, with 78% of eligible HIV-infected patients actually initiated on ART, and 80% within 8 weeks of diagnosis. ART could be extended to all HIV-infected TB patients irrespective of CD4 count with relatively little additional burden on the national ART programme.
2010 年，世界卫生组织（WHO）扩大了抗逆转录病毒治疗的推荐适应证，将所有 HIV 感染者合并结核病患者纳入治疗范围，而不考虑 CD4 计数。然而，印度仍然将抗逆转录病毒治疗（ART）限于 CD4 计数＜350/mm³或有肺外结核表现的结核病患者。我们旨在评估如果印度采用当前 2010 年 WHO 艾滋病合并结核病患者 ART 指南，将会有多少额外的患者开始接受 ART。
我们评估了 2010 年 6 月在高 HIV 流行的卡纳塔克邦，经修订的国家结核病控制规划治疗登记册中记录的所有结核病患者，并将 HIV 感染者合并结核病患者与 ART 规划记录进行交叉核对。
在登记的 6182 例结核病患者中，5761 例（93%）HIV 状况得到确认，710 例（12%）HIV 阳性。在结核病诊断前，146 例（21%）HIV 感染者合并结核病患者正在接受 ART。在其余的 564 例中，有 497 例（88%）接受了 ART 资格评估；其中，根据 2006 年 WHO ART 指南，436 例（88%）符合 ART 适应证。共有 487 例（69%）HIV 感染者合并结核病患者在结核病治疗期间接受了 ART。大约 80%的患者在结核病治疗后 8 周内开始 ART，95%接受了依非韦伦为基础的方案。
在印度卡纳塔克邦，根据 2006 年 WHO ART 指南，约十分之九的 HIV 感染者合并结核病患者有资格接受 ART。HIV 病例发现、ART 评估和 ART 启动的效率相对较高，符合条件的 HIV 感染者中有 78%实际上开始接受 ART，80%在诊断后 8 周内开始。可以将 ART 扩展到所有 HIV 感染者合并结核病患者，而无需对国家 ART 规划造成太大的额外负担，无论 CD4 计数如何。
