Karonga Prevention Study, Chilumba, Malawi.
AIDS. 2012 Nov 13;26(17):2233-9. doi: 10.1097/QAD.0b013e32835958ed.
To estimate the impact of antiretroviral therapy (ART) on the incidence of recurrent tuberculosis (TB) in an African population.
A long-term population cohort in Karonga District, northern Malawi.
Patients who had completed treatment for laboratory-confirmed TB diagnosed since 1996 were visited annually to record vital status, ART use and screen for TB. Survival analysis estimated the effect of HIV/ART status at completion of treatment on mortality and recurrence. Analyses were stratified by time since treatment completion to estimate the effects on relapse (predominates during first year) and reinfection disease (predominates later).
Among 1133 index TB cases contributing 4353 person-years of follow-up, there were 307 deaths and 103 laboratory-confirmed recurrences (recurrence rate 4.6 per 100 person-years). Half the recurrences occurred in the first year since completing treatment. HIV infection increased the recurrence rate [rate ratio adjusted for age, sex, period and TB type 2.69, 95% confidence interval (CI) 1.69-4.26], but with less effect in the first year (adjusted rate ratio 1.71, 95% CI 0.87-3.35) than subsequently (adjusted rate ratio 4.2, 95% CI 2.16-8.15). Recurrence rates on ART were intermediate between those of HIV-negative individuals and HIV-positive individuals without ART. Compared with HIV-positive individuals without ART, the adjusted rate ratio was 0.74 (95% CI 0.27-2.06) in the first year, and 0.43 (95% CI 0.11-1.73) later.
The increased incidence of TB recurrence observed in HIV-positive patients appeared to be reduced by ART. The effects are mostly on later (likely reinfection) disease so the impact of ART on reducing recurrence will be highest in high TB incidence settings.
评估抗逆转录病毒疗法（ART）对马拉维北部卡隆加区非洲人群中复发性结核病（TB）发病率的影响。
卡隆加区长期人群队列。
每年对完成自 1996 年以来确诊的实验室确认的 TB 治疗的患者进行随访，以记录生存状态、ART 使用情况和筛查 TB。生存分析估计治疗完成时 HIV/ART 状态对死亡率和复发率的影响。按治疗完成后时间分层分析，以估计对复发（主要发生在第一年）和再感染疾病（主要发生在后期）的影响。
在 1133 例 TB 指数病例中，共有 307 例死亡，103 例实验室确诊复发（复发率为 4.6/100 人年）。一半的复发发生在治疗完成后的第一年。HIV 感染增加了复发率[调整年龄、性别、时期和 TB 类型后比值比为 2.69，95%置信区间（CI）为 1.69-4.26]，但在第一年的效果较小（调整后比值比为 1.71，95%CI 为 0.87-3.35），随后效果较大（调整后比值比为 4.2，95%CI 为 2.16-8.15）。ART 上的复发率在 HIV 阴性个体和未接受 ART 的 HIV 阳性个体之间处于中间位置。与未接受 ART 的 HIV 阳性个体相比，第一年的调整后比值比为 0.74（95%CI 为 0.27-2.06），后期为 0.43（95%CI 为 0.11-1.73）。
在 HIV 阳性患者中观察到的 TB 复发发生率增加似乎因 ART 而降低。这些影响主要是在后期（可能是再感染）疾病，因此在高 TB 发病率环境中，ART 对降低复发的影响最大。
