Auld A F, Tuho M Z, Ekra K A, Kouakou J, Shiraishi R W, Adjorlolo-Johnson G, Marlink R, Ellerbrock T V
Division of Global HIV/AIDS, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA.
Ministry of Health, National Programme for Medical Care of Persons Living with HIV/AIDS, Abidjan, Côte d'Ivoire.
Int J Tuberc Lung Dis. 2014 Apr;18(4):381-7. doi: 10.5588/ijtld.13.0395.
In Côte d'Ivoire, more than 2000 human immunodeficiency virus (HIV) infected children aged <15 years were started on antiretroviral therapy (ART) during 2004-2008.
To estimate tuberculosis (TB) incidence and determinants among ART enrollees.
A nationally representative retrospective cohort study among 2110 children starting ART during 2004-2008 at 29 facilities.
At ART initiation, the median age was 5.1 years; 82% had World Health Organization Stage III/IV, median CD4% was 11%, 42% were severely undernourished (weight-for-age Z-score [WAZ] <-3), and 150 (7%) were taking anti-tuberculosis treatment. Documentation of TB screening before ART declined from 63% to 46% during 2004-2008. Children taking anti-tuberculosis treatment at ART enrollment had a lower median CD4% (9.0% vs. 11.0%, P = 0.037) and a higher prevalence of WAZ <-3 (59% vs. 40%, P < 0.001). Among children considered TB-free at ART enrollment, TB incidence was 6.28/100 child-years during days 0-90 of ART, declining to 0.56/100 child-years after 180 days. Children with one unit higher WAZ at ART enrollment had 13% lower TB incidence (adjusted HR 0.87, 95%CI 0.77-1.00, P= 0.047).
Ensuring clinician compliance with TB screening before ART and ensuring earlier ART initiation before children suffer from advanced HIV disease and nutritional compromise might reduce TB morbidity during ART.
在科特迪瓦，2004年至2008年期间，超过2000名15岁以下感染人类免疫缺陷病毒（HIV）的儿童开始接受抗逆转录病毒治疗（ART）。
评估接受ART治疗的儿童中结核病（TB）的发病率及其决定因素。
一项具有全国代表性的回顾性队列研究，研究对象为2004年至2008年期间在29家医疗机构开始接受ART治疗的2110名儿童。
开始接受ART治疗时，儿童的中位年龄为5.1岁；82%的儿童处于世界卫生组织III/IV期，CD4%的中位数为11%，42%的儿童严重营养不良（年龄别体重Z评分[WAZ]<-3），150名（7%）儿童正在接受抗结核治疗。2004年至2008年期间，ART治疗前结核病筛查的记录从63%降至46%。接受ART治疗时正在接受抗结核治疗的儿童，其CD?%的中位数较低（9.0%对11.0%，P = 0.037），WAZ<-3的患病率较高（59%对40%，P<0.001）。在接受ART治疗时被认为无结核病的儿童中，ART治疗第0至90天的结核病发病率为6.28/100儿童年，180天后降至0.56/100儿童年。接受ART治疗时WAZ每高一个单位的儿童，结核病发病率降低13%（校正风险比0.87，95%置信区间0.77-1.00，P = 0.047）。
确保临床医生在ART治疗前遵守结核病筛查规定，并确保在儿童患上晚期HIV疾病和营养状况恶化之前尽早开始ART治疗，可能会降低ART治疗期间的结核病发病率。
