Sihanouk Hospital Center of HOPE, Phnom Penh, Cambodia.
Trans R Soc Trop Med Hyg. 2013 Apr;107(4):235-42. doi: 10.1093/trstmh/trt001. Epub 2013 Jan 16.
Given the lack of detailed studies on tuberculosis (TB) in patients on antiretroviral treatment (ART) in South-East Asia, we aimed to determine the incidence and risk factors for early (after ≤6 months of ART) and late (after >6 months of ART) incident TB in Cambodia.
We conducted a retrospective analysis of all patients started on ART at a non-governmental hospital in Phnom Penh (March 2003-December 2010). TB diagnosis was performed according to WHO algorithms. Risk factor analysis was performed using multivariate Cox regression modeling.
Overall, 2984 patients started ART. The median baseline CD4 count was 89 cells µl(-1) (IQR 25-209), median age 34 years (IQR 29-40). Fifty-three percent of the patients were female. Median follow-up time on ART was 2.4 years. In addition to 932 (31.2%) patients already on TB treatment at ART initiation, 313 (10.5%) developed TB, with an overall incidence rate of 3.9/100 patient-years. Of those developing TB, 179 (6.0%) patients were diagnosed with early TB and 134 (4.5%) with late TB, corresponding with a rate of 13.5 and 2.0 per 100 patient-years respectively. Risk factors for early TB included low body mass index, low baseline CD4 count and low hemoglobin levels. Low on-treatment CD4 counts and hemoglobin levels, being underweight while on ART and prevalent TB were identified as risk factors for late TB.
The incidence of early TB was high, and predominantly associated with advanced HIV progression markers. Earlier ART initiation and enhanced TB screening prior to and after ART initiation is warranted. Late TB amounts to almost half of the total TB burden, meriting specific preventive and diagnostic approaches.
鉴于东南亚接受抗逆转录病毒治疗（ART）的患者中结核病（TB）缺乏详细研究，我们旨在确定柬埔寨患者中早期（ART 后≤6 个月）和晚期（ART 后>6 个月）TB 的发生率和危险因素。
我们对金边一家非政府医院 2003 年 3 月至 2010 年 12 月期间开始接受 ART 的所有患者进行了回顾性分析。TB 诊断符合世界卫生组织（WHO）的算法。采用多变量 Cox 回归模型进行危险因素分析。
总体而言，2984 名患者开始接受 ART。基线时 CD4 计数中位数为 89 个细胞/µl(-1)（25-209 个细胞/µl），年龄中位数为 34 岁（29-40 岁）。53%的患者为女性。ART 治疗中位随访时间为 2.4 年。除了 932 名（31.2%）在开始 ART 时已接受 TB 治疗的患者外，313 名（10.5%）发生了 TB，总发病率为 3.9/100 人年。在发生 TB 的患者中，179 名（6.0%）患者被诊断为早期 TB，134 名（4.5%）为晚期 TB，分别相当于每 100 人年 13.5 和 2.0 例。早期 TB 的危险因素包括低体重指数、低基线 CD4 计数和低血红蛋白水平。治疗期间低 CD4 计数和血红蛋白水平、ART 期间体重不足以及存在 TB 是晚期 TB 的危险因素。
早期 TB 的发病率较高，主要与 HIV 进展标志物晚期相关。需要提前和 ART 后尽早开始 ART，并加强 TB 筛查。晚期 TB 占总 TB 负担的近一半，需要采取特定的预防和诊断方法。
