Centers for Disease Control and Prevention Botswana, Gaborone and Francistown, Botswana.
Int J Tuberc Lung Dis. 2013 Feb;17(2):178-85. doi: 10.5588/ijtld.12.0314.
Eight public health clinics in Gaborone and Francistown, Botswana.
To describe the characteristics and outcomes of incident tuberculosis (TB) cases in human immunodeficiency virus (HIV) infected adults exposed to isoniazid preventive therapy (IPT) with access to antiretroviral and anti-tuberculosis treatment.
In 1995 HIV-infected adults, TB disease was excluded before commencing IPT. During and after receipt of 6 or 36 months of IPT, symptomatic participants were evaluated using chest radiographs, sputum microscopy, cultures and drug susceptibility testing (DST). Incident TB cases received ≥6 months of anti-tuberculosis treatment.
Seventy-five incident TB cases were identified among 619 symptomatic participants. The median duration of IPT in these cases was 6 months (range 1-35), and the median time to initiation of anti-tuberculosis treatment was 12 months after IPT cessation. Antiretroviral therapy (ART) was initiated before anti-tuberculosis treatment in 37 cases. Culture was positive in 43/58 (74%) TB cultures. DST was available for 38 cases, of which six (16%) were resistant to isoniazid (INH); 67/75 (89%) cases, including four with INH-monoresistant TB, completed anti-tuberculosis treatment or were cured.
With prompt initiation of anti-tuberculosis treatment and access to ART, excellent outcomes were achieved in a public health setting in HIV-infected adults who developed TB disease.
博茨瓦纳哈博罗内和弗朗西斯敦的 8 个公共卫生诊所。
描述接受异烟肼预防治疗（IPT）且有机会获得抗逆转录病毒和抗结核治疗的艾滋病毒（HIV）感染者中出现的结核（TB）病例的特征和结局。
1995 年，HIV 感染者在开始 IPT 前排除 TB 疾病。在接受 6 或 36 个月 IPT 期间和之后，出现症状的参与者使用胸部 X 光片、痰显微镜检查、培养和药敏试验（DST）进行评估。出现的 TB 病例接受了≥6 个月的抗结核治疗。
在 619 例有症状的参与者中发现了 75 例新发 TB 病例。这些病例中 IPT 的中位数持续时间为 6 个月（范围 1-35），IPT 停止后开始抗结核治疗的中位数时间为 12 个月。在 37 例中，在开始抗结核治疗前开始了抗逆转录病毒治疗（ART）。在 58 例 TB 培养物中，有 43 例（74%）培养阳性。DST 可用于 38 例，其中 6 例（16%）对异烟肼（INH）耐药；75 例病例中的 67 例（89%），包括 4 例 INH 单耐药性 TB，完成了抗结核治疗或被治愈。
在 HIV 感染者中，在公共卫生环境中出现 TB 疾病时，通过及时开始抗结核治疗和获得 ART，可以获得极好的结局。
