Mugusi Sabina F, Ngaimisi Eliford, Janabi Mohamed Y, Mugusi Ferdinand M, Minzi Omary M S, Sasi Philip G, Bakari Muhammad, Lindquist Lars, Aklillu Eleni, Sandstrom Eric G
Department of Internal Medicine, Muhimbili National Hospital, Dar es Salaam, Tanzania.
Antivir Ther. 2012;17(2):265-74. doi: 10.3851/IMP1956. Epub 2011 Nov 17.
The aim of this study was to describe risk factors for mortality and clinical characteristics of HIV-infected patients with and without tuberculosis (TB) coinfection.
A cohort of HIV-infected patients with CD4(+) T-cell counts of ≤200 cells/μl was recruited, consisting of 255 HIV-infected patients without active TB and 231 patients with active TB. All received a well-supervised treatment with an efavirenz-based HAART, and those coinfected with TB received appropriate anti-TB treatment. They were followed up for 48 weeks after HAART initiation.
Common presenting symptoms in HIV-only patients were fever (36.5%), headache (34.5%), skin rash (34.5%) and weight loss (32%), while in HIV-TB patients the symptoms were weight loss (58%), cough (57.6%), night sweats (44.6%) and fever (34.2%). HIV-TB patients had significantly lower body mass index, Karnofsky scores and haemoglobin levels compared to those infected with HIV only, despite similar baseline CD4(+) T-cell counts. Overall, 12 (4.7%) HIV patients developed TB and 7 (3%) HIV-TB patients had worsening of their TB symptoms during the study period. Mortality was similar in the two groups, being 10.9% (16 deaths per 100 person years) and 11.3% (17 deaths per 100 person years) in HIV-only and HIV-TB patients, respectively. Overall, more males (13.1%) died compared to females (9.6%). Predictors of mortality were presence of oral candidiasis, Kaposi's sarcoma, low Karnofsky score, and low baseline white blood cell and CD4(+) T-cell counts.
The outcomes following well-supervised treatment of HIV-TB patients are similar to those in patients with HIV alone. Predictors of mortality were those of advanced disease.
本研究旨在描述合并或未合并结核病（TB）感染的HIV感染患者的死亡风险因素及临床特征。
招募了一组CD4(+) T细胞计数≤200个细胞/μl的HIV感染患者，其中包括255例无活动性结核病的HIV感染患者和231例活动性结核病患者。所有患者均接受了以依非韦伦为基础的高效抗逆转录病毒治疗（HAART）的严密监测，合并结核病的患者接受了适当的抗结核治疗。在开始HAART治疗后对他们进行了48周的随访。
仅感染HIV的患者常见的症状为发热（36.5%）、头痛（34.5%）、皮疹（34.5%）和体重减轻（32%），而HIV-TB患者的症状为体重减轻（58%）、咳嗽（57.6%）、盗汗（44.6%）和发热（34.2%）。尽管基线CD4(+) T细胞计数相似，但与仅感染HIV的患者相比，HIV-TB患者的体重指数、卡诺夫斯基评分和血红蛋白水平显著更低。总体而言，在研究期间，12例（4.7%）HIV患者发生了结核病，7例（3%）HIV-TB患者的结核病症状加重。两组的死亡率相似，仅感染HIV的患者和HIV-TB患者的死亡率分别为10.9%（每100人年16例死亡）和11.3%（每100人年17例死亡）。总体而言，男性死亡者（13.1%）多于女性（9.6%）。死亡的预测因素包括口腔念珠菌病、卡波西肉瘤、低卡诺夫斯基评分以及低基线白细胞和CD4(+) T细胞计数。
对HIV-TB患者进行严密监测治疗后的结果与仅感染HIV的患者相似。死亡的预测因素为疾病晚期的因素。
