抗反转录病毒疗法对高收入国家 HIV 阳性患者结核病发病率的影响。
Impact of antiretroviral therapy on tuberculosis incidence among HIV-positive patients in high-income countries.
出版信息
Clin Infect Dis. 2012 May;54(9):1364-72. doi: 10.1093/cid/cis203. Epub 2012 Mar 28.
BACKGROUND
The lower tuberculosis incidence reported in human immunodeficiency virus (HIV)-positive individuals receiving combined antiretroviral therapy (cART) is difficult to interpret causally. Furthermore, the role of unmasking immune reconstitution inflammatory syndrome (IRIS) is unclear. We aim to estimate the effect of cART on tuberculosis incidence in HIV-positive individuals in high-income countries.
METHODS
The HIV-CAUSAL Collaboration consisted of 12 cohorts from the United States and Europe of HIV-positive, ART-naive, AIDS-free individuals aged ≥18 years with baseline CD4 cell count and HIV RNA levels followed up from 1996 through 2007. We estimated hazard ratios (HRs) for cART versus no cART, adjusted for time-varying CD4 cell count and HIV RNA level via inverse probability weighting.
RESULTS
Of 65 121 individuals, 712 developed tuberculosis over 28 months of median follow-up (incidence, 3.0 cases per 1000 person-years). The HR for tuberculosis for cART versus no cART was 0.56 (95% confidence interval [CI], 0.44-0.72) overall, 1.04 (95% CI, 0.64-1.68) for individuals aged >50 years, and 1.46 (95% CI, 0.70-3.04) for people with a CD4 cell count of <50 cells/μL. Compared with people who had not started cART, HRs differed by time since cART initiation: 1.36 (95% CI, 0.98-1.89) for initiation <3 months ago and 0.44 (95% CI, 0.34-0.58) for initiation ≥3 months ago. Compared with people who had not initiated cART, HRs <3 months after cART initiation were 0.67 (95% CI, 0.38-1.18), 1.51 (95% CI, 0.98-2.31), and 3.20 (95% CI, 1.34-7.60) for people <35, 35-50, and >50 years old, respectively, and 2.30 (95% CI, 1.03-5.14) for people with a CD4 cell count of <50 cells/μL.
CONCLUSIONS
Tuberculosis incidence decreased after cART initiation but not among people >50 years old or with CD4 cell counts of <50 cells/μL. Despite an overall decrease in tuberculosis incidence, the increased rate during 3 months of ART suggests unmasking IRIS.
背景
在接受联合抗逆转录病毒治疗（cART）的艾滋病毒（HIV）阳性个体中，结核病发病率较低，这很难从因果关系上解释。此外，免疫重建炎症综合征（IRIS）的作用尚不清楚。我们旨在估计 cART 对高收入国家 HIV 阳性个体结核病发病率的影响。
方法
HIV-CAUSAL 协作由来自美国和欧洲的 12 个队列组成，这些队列由年龄≥18 岁、基线 CD4 细胞计数和 HIV RNA 水平的 HIV 阳性、ART 初治、无艾滋病个体组成，从 1996 年至 2007 年进行随访。我们通过逆概率加权法，根据时变的 CD4 细胞计数和 HIV RNA 水平，估计 cART 与无 cART 相比的危险比（HR）。
结果
在中位随访 28 个月期间，65121 名个体中有 712 人发生结核病（发病率为每 1000 人年 3.0 例）。cART 与无 cART 相比，结核病的 HR 总体为 0.56（95%置信区间[CI]，0.44-0.72），年龄>50 岁者为 1.04（95%CI，0.64-1.68），CD4 细胞计数<50 个/μL 者为 1.46（95%CI，0.70-3.04）。与未开始 cART 的个体相比，cART 开始后不同时间的 HR 不同：cART 开始<3 个月的 HR 为 1.36（95%CI，0.98-1.89），cART 开始≥3 个月的 HR 为 0.44（95%CI，0.34-0.58）。与未开始 cART 的个体相比，cART 开始后 3 个月内的 HR 分别为<35 岁者为 0.67（95%CI，0.38-1.18），35-50 岁者为 1.51（95%CI，0.98-2.31），>50 岁者为 3.20（95%CI，1.34-7.60），CD4 细胞计数<50 个/μL 者为 2.30（95%CI，1.03-5.14）。
结论
cART 启动后结核病发病率下降，但在年龄>50 岁或 CD4 细胞计数<50 个/μL 的人群中无此现象。尽管结核病发病率总体下降，但在接受 ART 的 3 个月内发病率增加提示 IRIS 显现。
Zotero 插件