Integrated Treatment Centre, Special Preventive Programme, Centre for Health Protection, Department of Health, Hong Kong.
Hong Kong Med J. 2013 Oct;19(5):386-92. doi: 10.12809/hkmj133892. Epub 2013 Aug 8.
To evaluate whether a policy to treat latent tuberculosis identified by annual tuberculin sensitivity testing is effective for tuberculosis control in human immunodeficiency virus-infected patients in Hong Kong.
Historical cohort study.
Integrated Treatment Centre, Department of Health, Hong Kong.
Patients infected with human immunodeficiency virus without a history of tuberculosis were offered annual tuberculin sensitivity testing, coupled with treatment of latent tuberculosis if they tested positive. All such patients were followed for new tuberculosis.
In all, 1154 patients on antiretroviral therapy, contributing to 5587 patient-years of observation, were analysed; 1032 patients (89%) received annual tuberculin sensitivity testing. Their baseline characteristics, including CD4 counts and other risk factors for tuberculosis, did not differ significantly from those who declined testing. The overall incidence rate of tuberculosis was 0.59 case per 100 patient-years. It was lower in those who received annual tuberculin sensitivity testing than those who did not (0.41 vs 3.85 per 100 patient-years; P<0.0001). Only a low baseline CD4 count and a history of tuberculin sensitivity testing were shown to be significant indicators of incident tuberculosis using multivariate analysis. The hazard ratio was 0.36 (95% confidence interval, 0.16-0.85; P=0.02) for those with a baseline CD4 count of 100/mm3 or above, and 0.26 (95% confidence interval, 0.08-0.77; P=0.016) for those who received annual tuberculin sensitivity testing. The incidence of tuberculosis was highest within 90 days of antiretroviral therapy initiation.
The established policy continues to be effective. The high risk of tuberculosis during the early period of antiretroviral therapy supports early use of tuberculin sensitivity testing. Alternatively, the strategy of universal isoniazid preventive therapy at antiretroviral therapy initiation could be studied for those with very low baseline CD4 counts.
评估在香港对通过年度结核菌素敏感性检测发现的潜伏性结核进行治疗的政策对控制 HIV 感染者中的结核是否有效。
历史性队列研究。
香港卫生署综合治疗中心。
没有结核病病史的 HIV 感染者接受年度结核菌素敏感性检测，如果检测结果为阳性，则接受潜伏性结核治疗。所有这些患者都接受了新发结核的随访。
共有 1154 名接受抗逆转录病毒治疗的患者（共 5587 患者年的观察）参与分析；1032 名（89%）患者接受了年度结核菌素敏感性检测。他们的基线特征，包括 CD4 计数和其他结核危险因素，与拒绝检测者无显著差异。结核的总发病率为 0.59 例/100 患者年。接受年度结核菌素敏感性检测的患者发病率低于未接受者（0.41 比 3.85 例/100 患者年；P<0.0001）。仅低基线 CD4 计数和结核菌素敏感性检测史被证明是使用多变量分析显示结核发病的重要指标。对于基线 CD4 计数为 100/mm3 或以上的患者，风险比为 0.36（95%置信区间，0.16-0.85；P=0.02），对于接受年度结核菌素敏感性检测的患者，风险比为 0.26（95%置信区间，0.08-0.77；P=0.016）。抗逆转录病毒治疗开始后 90 天内结核发病率最高。
既定政策继续有效。抗逆转录病毒治疗早期结核的高风险支持早期使用结核菌素敏感性检测。或者，对于基线 CD4 计数非常低的患者，可考虑在抗逆转录病毒治疗开始时采用普遍异烟肼预防治疗策略。
