*Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa; †Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; and ‡Oxford Department of Public Health, University of Oxford, Oxford, United Kingdom.
J Acquir Immune Defic Syndr. 2014 Apr 1;65(4):438-46. doi: 10.1097/QAI.0000000000000060.
The challenge of early tuberculosis (TB) infection among rural patients accessing highly active antiretroviral therapy (HAART) in a resource-limited setting with high HIV and TB burden has not been fully quantified.
This is a retrospective study nested within a prospective study of 969 patients consecutively initiated onto HAART at the CAPRISA AIDS Treatment programme in rural KwaZulu-Natal between January 2007 and December 2010. Patients were screened for clinical symptoms consistent with TB using a standardized checklist, and routine clinical investigations that included sputum microscopy and chest x-ray diagnosis.
Of 969 HIV-infected patients initiated on HAART, 173 [17.9%; 95% confidence interval (CI): 15.5 to 20.4] had active TB at HAART initiation. TB incidence rates were 3-fold higher in the first 3 months (early incident TB) after HAART initiation [11.5/100 person-years (py); 95% CI: 7.1 to 17.5] compared with 4-24 months (late incident TB) post-HAART initiation (3.2/100 py; 95% CI: 2.2 to 4.5; incidence rate ratio: 3.6; 95% CI: 2.0 to 6.4; P < 0.001). Immune status of patients at HAART initiation did not impact TB incidence rates in patients with CD4 counts of <50 (5.3/100) and >200 (4.9/100 py; P = 0.81) cells per cubic millimeter. CD4 count gains achieved 12 months post-HAART initiation were significantly different in patients with early incident TB versus late incident TB; P = 0.03.
Rural HIV treatment programmes in TB-endemic settings experience high rates of TB irrespective of immunologic status of patients at HAART initiation, or duration on HAART.
在资源有限、艾滋病毒和结核病负担高的环境中，农村地区接受高效抗逆转录病毒疗法（HAART）的患者中早期结核病（TB）感染的挑战尚未得到充分量化。
这是一项回顾性研究，嵌套在一项前瞻性研究中，该研究纳入了 2007 年 1 月至 2010 年 12 月期间在夸祖鲁-纳塔尔省卡普里萨艾滋病治疗项目中连续接受 HAART 的 969 例患者。使用标准化检查表和常规临床检查（包括痰显微镜检查和胸部 X 光诊断）对患者进行符合结核病临床症状的筛查。
在接受 HAART 的 969 例 HIV 感染患者中，173 例（17.9%；95%置信区间[CI]：15.5 至 20.4）在 HAART 起始时患有活动性结核病。与 HAART 起始后 4-24 个月（晚期发病性 TB）相比，HAART 起始后 3 个月内（早期发病性 TB）的 TB 发病率高 3 倍[11.5/100 人年（py）；95%CI：7.1 至 17.5]（4-24 个月）[3.2/100 py；95%CI：2.2 至 4.5；发病率比：3.6；95%CI：2.0 至 6.4；P < 0.001]。HAART 起始时患者的免疫状态并未影响 CD4 计数<50（5.3/100）和>200（4.9/100 py；P = 0.81）个细胞/mm3的患者的 TB 发病率。HAART 起始后 12 个月时获得的 CD4 计数增益在早期发病性 TB 与晚期发病性 TB 患者之间存在显著差异；P = 0.03。
在结核病流行地区，农村 HIV 治疗方案中无论患者在 HAART 起始时的免疫状态如何，或接受 HAART 的时间长短，均会出现较高的结核病发病率。
