南非德班开始抗逆转录病毒疗法的 HIV 感染患者中的耐多药结核病。

Drug-resistant tuberculosis among HIV-infected patients starting antiretroviral therapy in Durban, South Africa.

机构信息

Harvard Medical School, Boston, Massachusetts, United States of America.

出版信息

PLoS One. 2012;7(8):e43281. doi: 10.1371/journal.pone.0043281. Epub 2012 Aug 17.

DOI:10.1371/journal.pone.0043281

PMID:22912845

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3422270/

Abstract

OBJECTIVE

To estimate the prevalence of drug-resistant tuberculosis (TB) and describe the resistance patterns in patients commencing antiretroviral therapy (ART) in an HIV clinic in Durban, South Africa.

DESIGN

Cross-sectional cohort study.

METHODS

Consecutive HIV-infected adults (≥ 18y/o) initiating HIV care were enrolled from May 2007-May 2008, regardless of signs or symptoms of active TB. Prior TB history and current TB treatment status were self-reported. Subjects expectorated sputum for culture (MGIT liquid and 7H11 solid medium). Positive cultures were tested for susceptibility to first- and second-line anti-tuberculous drugs. The prevalence of drug-resistant TB, stratified by prior TB history and current TB treatment status, was assessed.

RESULTS

1,035 subjects had complete culture results. Median CD4 count was 92/µl (IQR 42-150/µl). 267 subjects (26%) reported a prior history of TB and 210 (20%) were receiving TB treatment at enrollment; 191 (18%) subjects had positive sputum cultures, among whom the estimated prevalence of resistance to any antituberculous drug was 7.4% (95% CI 4.0-12.4). Among those with prior TB, the prevalence of resistance was 15.4% (95% CI 5.9-30.5) compared to 5.2% (95% CI 2.1-8.9) among those with no prior TB. 5.1% (95% CI 2.4-9.5) had rifampin or rifampin plus INH resistance.

CONCLUSIONS

The prevalence of TB resistance to at least one drug was 7.4% among adults with positive TB cultures initiating ART in Durban, South Africa, with 5.1% having rifampin or rifampin plus INH resistance. Improved tools for diagnosing TB and drug resistance are urgently needed in areas of high HIV/TB prevalence.

摘要

目的

评估耐多药结核病（TB）的流行率，并描述在南非德班的一个艾滋病毒诊所开始抗逆转录病毒治疗（ART）的患者中的耐药模式。

设计

横断面队列研究。

方法

2007 年 5 月至 2008 年 5 月，连续入组开始艾滋病毒护理的艾滋病毒感染成年人（≥18 岁），无论是否有活动性结核病的症状或体征。既往结核病史和当前结核病治疗状况为自我报告。受试者咳出痰液进行培养（MGIT 液体和 7H11 固体培养基）。对阳性培养物进行一线和二线抗结核药物敏感性测试。评估按既往结核病史和当前结核病治疗状况分层的耐药性结核病的流行率。

结果

1035 例患者具有完整的培养结果。中位 CD4 计数为 92/µl（IQR 42-150/µl）。267 例（26%）患者报告有既往结核病史，210 例（20%）患者在入组时正在接受结核病治疗；191 例（18%）患者的痰液培养阳性，其中任何抗结核药物耐药的估计流行率为 7.4%（95%CI 4.0-12.4）。在有既往结核病的患者中，耐药率为 15.4%（95%CI 5.9-30.5），而无既往结核病的患者耐药率为 5.2%（95%CI 2.1-8.9）。5.1%（95%CI 2.4-9.5）患者有利福平或利福平加 INH 耐药。