Bwana Veneranda, Tenu Filemoni, Magesa Stephen M, Mfinanga Sayoki G
National Institute for Medical Research, Amani Research Centre, P.O. Box 81, Muheza, Tanzania.
National Institute for Medical Research, Muhimbili Research Centre, Dar es Salaam, Tanzania.
Tanzan J Health Res. 2011 Jan;13(1):14-20. doi: 10.4314/thrb.v13i1.62113.
Globally, tuberculosis-HIV co-infections are on the increase. In 2007, 15% (1.37 million) of the tuberculosis cases were HIV-positive tuberculosis (TB). This cross-sectional study was conducted in February 2009 to assess the effect of the level of CD4 lymphocyte counts on the development of smear positive pulmonary TB (PTB) among HIV patients before and after initiation of highly active antiretroviral therapy (HAART). A total of 155 HIV patients who were on HAART programme were enrolled and out of these 42 (27.1%) were smear positive PTB. Of the 42 PTB patients, 38 (90.5%) were also infected with HIV and were already at initiation of HAART. There was no association between the development of smear positive PTB and socio-demographic characteristics among HIV patients before and after HAART initiation (P>0.05). A larger proportion of HIV+PTB patients diagnosed before and after HAART initiation was found with CD4 lymphocyte count <200cells/microl. However, the difference was not statistically significant (P =0.092). Among HIV patients who were diagnosed to be smear positive PTB after HAART initiation, their CD4 lymphocyte counts at time of TB diagnosis was lower than their CD4 lymphocyte counts at time of HAART initiation. The four patients diagnosed with PTB after HAART initiation had mean CD4 lymphocyte counts at HAART initiation not statistically different from that at TB diagnosis (t=0.715, P=0.526). The median time period within which the diagnosis of smear positive PTB was made after HAART initiation was 22 weeks and the mean time was 66.75 weeks. These findings provide evidence that development of smear positive PTB after HAART initiation may occur at any level of CD4 lymphocyte count (P<0.05). This study was limited by the relatively small sample size, we therefore recommend more studies involving a larger sample size in order to estimate more accurately the effect of both level of CD4 lymphocyte count and HAART on the development of smear positive PTB among HIV patients on treatment.
在全球范围内，结核病与艾滋病病毒合并感染的情况正在增加。2007年，15%（137万）的结核病病例为艾滋病病毒阳性的结核病（TB）。这项横断面研究于2009年2月进行，旨在评估在高效抗逆转录病毒治疗（HAART）启动前后，CD4淋巴细胞计数水平对艾滋病病毒患者涂片阳性肺结核（PTB）发病的影响。共有155名接受HAART治疗方案的艾滋病病毒患者被纳入研究，其中42名（27.1%）为涂片阳性PTB。在这42名PTB患者中，38名（90.5%）也感染了艾滋病病毒，并且在开始HAART时就已经感染。在HAART启动前后，艾滋病病毒患者中涂片阳性PTB的发病与社会人口学特征之间没有关联（P>0.05）。在HAART启动前后被诊断出的艾滋病病毒合并PTB患者中，较大比例的患者CD4淋巴细胞计数<200个/微升。然而，差异无统计学意义（P =0.092）。在HAART启动后被诊断为涂片阳性PTB的艾滋病病毒患者中，他们在结核病诊断时的CD4淋巴细胞计数低于开始HAART时的CD4淋巴细胞计数。在HAART启动后被诊断为PTB的4名患者，其开始HAART时的平均CD4淋巴细胞计数与结核病诊断时的平均CD4淋巴细胞计数无统计学差异（t=0.715，P=0.526）。HAART启动后做出涂片阳性PTB诊断的中位时间为22周，平均时间为66.75周。这些发现提供了证据，表明HAART启动后涂片阳性PTB的发病可能发生在任何CD4淋巴细胞计数水平（P<0.05）。本研究受到样本量相对较小的限制，因此我们建议开展更多涉及更大样本量的研究，以便更准确地评估CD4淋巴细胞计数水平和HAART对接受治疗的艾滋病病毒患者中涂片阳性PTB发病的影响。
