Public Health Strengthening Guyana Project/Canadian Society for International Health, Ottawa, Ontario, Canada.
Int J Infect Dis. 2012 Sep;16(9):e684-6. doi: 10.1016/j.ijid.2012.05.1026. Epub 2012 Jul 10.
The objective of this study was to describe the sociodemographic and clinical characteristics of patients dually infected with HIV and tuberculosis (TB) in Guyana.
The data for this study were obtained as part of a related project conducted to determine the prevalence of diabetes mellitus among TB patients in Guyana. From April to June 2006, a convenience sample of 100 patients was selected from those attending three TB clinics in Guyana and a structured questionnaire was used to collect relevant sociodemographic and risk factor data. The sociodemographic and clinical data of HIV-negative and HIV-positive patients with pulmonary TB were compared. Logistic regression was conducted to determine independent relationships between sociodemographic and clinical features.
One hundred TB patients were considered for enrolment in the study, but since the HIV status was known for only 77 persons, these were included in the analysis. Thirty-one of the 77 (40.3%) were HIV-positive. Seventy-two of the 77 (93.5%) patients had pulmonary TB, 28 of whom were HIV-positive; the other five had extrapulmonary TB, three of whom were dually infected. Several social factors and clinical manifestations including incarceration at the time of TB diagnosis (p=0.01), cigarette smoking (p=0.05), homelessness (p=0.07), chest pain (p=0.001), hemoptysis (p=0.02), cough (p=0.08), and being acid-fast bacillus (AFB) sputum smear-positive (p=0.06) were associated with HIV-negative pulmonary TB. In the logistic regression model, HIV-negative TB patients demonstrated higher frequencies of complaints of chest pain (odds ratio (OR) 34.48, 95% confidence interval (CI) 4.35-250) and were more likely to be AFB sputum smear-positive (OR 11.97, 95% CI 1.91-74.76) than HIV-positive TB patients.
Guyana is faced with a particularly high burden of HIV infection among TB patients. Given the impact of HIV on the clinical presentation of TB, physicians managing HIV patients should demonstrate a high level of suspicion for TB among these patients. Incarceration is a strong correlate of TB, overall.
本研究旨在描述圭亚那同时感染艾滋病毒和结核病（TB）的患者的社会人口学和临床特征。
本研究的数据来自圭亚那的一个相关项目，该项目旨在确定糖尿病在圭亚那结核病患者中的患病率。2006 年 4 月至 6 月，从圭亚那的三个结核病诊所中选择了 100 名方便的患者作为样本，并使用结构化问卷收集了相关的社会人口学和危险因素数据。比较了 HIV 阴性和 HIV 阳性肺结核患者的社会人口学和临床数据。进行逻辑回归分析以确定社会人口学和临床特征之间的独立关系。
考虑将 100 名结核病患者纳入研究，但由于仅对 77 名患者的 HIV 状况有所了解，因此仅对这些患者进行了分析。77 名患者中有 31 名（40.3%）为 HIV 阳性。77 名患者中有 72 名（93.5%）患有肺结核，其中 28 名 HIV 阳性；其余五人患有肺外结核病，其中三人同时感染了 HIV。一些社会因素和临床表现，包括在结核病诊断时被监禁（p=0.01）、吸烟（p=0.05）、无家可归（p=0.07）、胸痛（p=0.001）、咯血（p=0.02）、咳嗽（p=0.08）和抗酸杆菌（AFB）痰涂片阳性（p=0.06），与 HIV 阴性肺结核有关。在逻辑回归模型中，与 HIV 阳性肺结核患者相比，HIV 阴性肺结核患者更常出现胸痛（比值比（OR）34.48，95%置信区间（CI）4.35-250）和 AFB 痰涂片阳性（OR 11.97，95% CI 1.91-74.76）的报告。
圭亚那面临着 HIV 感染在结核病患者中特别高的负担。鉴于 HIV 对结核病临床表现的影响，管理 HIV 患者的医生应该对这些患者中结核病的发生保持高度怀疑。总体而言，监禁是结核病的一个强烈相关因素。
