在埃塞俄比亚亚的斯亚贝巴，开始抗逆转录病毒治疗后艾滋病毒感染者成人中结核病发生的相关决定因素：一项病例对照研究。
Determinant factors associated with occurrence of tuberculosis among adult people living with HIV after antiretroviral treatment initiation in Addis Ababa, Ethiopia: a case control study.
机构信息
Department of Public Health, College of Medical and Health Science, Wollega University, Nekemte, Ethiopia.
出版信息
PLoS One. 2013 May 21;8(5):e64488. doi: 10.1371/journal.pone.0064488. Print 2013.
INTRODUCTION
Tuberculosis (TB) is a leading morbidity and mortality, and the first presenting sign in majority of people living with Human Immune deficiency Virus (PLWH). Determinants of active TB among HIV patients on anti retroviral treatment (ART) are not well described in resource limited settings. The aim of this study was to assess determinant factors for the occurrence of TB among people living with HIV after ART initiation in public hospitals and health centers in Addis Ababa, Ethiopia.
METHODS AND FINDINGS
A case control study was conducted from December 2011 to February 2012 in 2 public hospitals and 13 health centers in Addis Ababa. The study population consisted of 204 cases and 409 controls. Cases were adult people living with HIV who developed TB after ART initiation and controls were adult people living with HIV who did not develop TB after ART initiation. An interviewer administered structured questionnaire was used to collect information. After adjustment for potential confounders, presence of isoniazid prophylaxis (adjusted odd ratio [AOR] 0.35, 95% confidence interval [CI] 0.125, 0.69) and cotrimoxazole prophylaxis (AOR = 0.19; 95% CI: 0.06, 0.62) had protective benefit against risk of TB. In contrary, bedridden (AOR = 9.36; 95% CI: 3.39, 25.85), having World Health Organization (WHO) clinical stage III/IV (AOR = 3.40; 95% CI: 1.69, 6.87) and hemoglobin level <10 mg/dl (AOR = 7.43; 95% CI; 3.04, 18.31) at enrollment to ART care were predictors for increased risk of tuberculosis in PLWH after ART initiation.
CONCLUSION
Increasing coverage of isoniazid preventive therapy and cotrimoxazole preventive therapy reduced risk of TB among HIV patients who started treatment. All PLWH should be screened for TB, but for patients who have advanced disease condition (WHO clinical stage III/IV, being bedridden and having hemoglobin level <10 mg/dl) intensified screening is highly recommended during treatment follow up.
引言
结核病（TB）是发病率和死亡率的主要原因，也是大多数人类免疫缺陷病毒（PLWH）感染者的首要表现。在资源有限的环境中，抗逆转录病毒治疗（ART）的 HIV 感染者中发生活动性结核病的决定因素尚未得到很好的描述。本研究旨在评估在埃塞俄比亚亚的斯亚贝巴的公立医院和卫生中心，接受 ART 治疗后 HIV 感染者中结核病发生的决定因素。
方法和发现
2011 年 12 月至 2012 年 2 月，在 2 家公立医院和 13 家卫生中心进行了病例对照研究。研究人群包括 204 例病例和 409 例对照。病例为接受 ART 治疗后发生结核病的成年 HIV 感染者，对照为接受 ART 治疗后未发生结核病的成年 HIV 感染者。采用访谈者管理的结构化问卷收集信息。在调整潜在混杂因素后，异烟肼预防治疗（调整后的比值比[OR]0.35，95%置信区间[CI]0.125，0.69）和复方磺胺甲噁唑预防治疗（OR=0.19；95%CI：0.06，0.62）对结核病的风险具有保护作用。相反，卧床不起（OR=9.36；95%CI：3.39，25.85）、世界卫生组织（WHO）临床分期 III/IV 期（OR=3.40；95%CI：1.69，6.87）和血红蛋白水平<10mg/dl（OR=7.43；95%CI；3.04，18.31）在开始接受 ART 护理时，是 PLWH 在接受 ART 治疗后发生结核病风险增加的预测因素。
结论
增加异烟肼预防性治疗和复方磺胺甲噁唑预防性治疗的覆盖率可降低开始治疗的 HIV 患者发生结核病的风险。所有 PLWH 都应进行结核病筛查，但对于病情较重的患者（WHO 临床分期 III/IV 期、卧床不起和血红蛋白水平<10mg/dl），在治疗随访期间应强烈推荐强化筛查。
Zotero 插件