Oprea Cristiana, Ianache Irina, Radoi Roxana, Erscoiu Simona, Tardei Gratiela, Nicolaescu Olimpia, Nica Maria, Calistru Petre, Ruta Simona, Ceausu Emanoil
HIV, Victor Babes Clinical Hospital for Infectious and Tropical Diseases, Bucharest, Romania.
Laboratory of Immunology and Virology, Victor Babes Clinical Hospital for Infectious and Tropical Diseases, Bucharest, Romania.
J Int AIDS Soc. 2014 Nov 2;17(4 Suppl 3):19625. doi: 10.7448/IAS.17.4.19625. eCollection 2014.
In the last years, we observed an alarming increase in the number of newly diagnosed HIV infected intravenous drug users (IDUs) co-infected with hepatitis viruses or with severe bacterial infections. The aim of our study was to assess the incidence, the demographic and clinical characteristics of IDUs diagnosed with HIV, HCV and tuberculosis (TB).
Prospective study on HIV infected IDUs with HCV and TB admitted in a single centre between January 2009 and April 2014. Data were compared to a group of HIV infected IDUs without TB. Statistical analysis was performed using Graphpad Prism 4.01.
Out of 450 HIV infected IDUs, 134 (29.7%) were diagnosed with HIV, HCV and TB. TB incidence among IDUs increases from 0% in 2009 to 30.2% in 2013. The TB coinfected patients had a mean age at diagnosis of 30 [15-56] years; were in majority males, 106 (84.4%); from urban areas, 120 (89.5%); and had significantly lower education level (85% vs 68.3%, p<0.0001) and higher rates of unemployment (80% vs 55%, p<0.0001) than those without TB. The median CD4 cell count was lower in the TB versus non TB IDUs (143 vs 472/mm(3), p<0.0001). TB infected IDUs tend to be more frequently late presenters (59.7 vs 24.6, p<0.0001) and to have advanced HIV disease (47.7 vs 7.59%, p<0.0001) than those without TB. TB cultures were positive in 64 (47.7%) patients, 3 (2.2%) had multidrug resistant TB and 2 (1.5%) had extended drug resistance. Disseminated and/or extrapulmonary TB was diagnosed in 51 patients (38%). The overall mortality rate was higher in TB compared to non TB IDUs (19.4% vs 8.2%, p=0.0007), disseminated TB being associated with the most severe immunosuppression (median CD4 cell count 42/mm(3)) and the highest mortality rate (27.4%).
The incidence of TB in HIV/HCV coinfected IDUs was high and rose over the time. TB infection was more frequent in patients with severe immunosuppression and the mortality rate was higher in IDUs with disseminated and/or extrapulmonary disease. IDUs are important candidates for acquiring and transmitting HIV infection, viral hepatitis and TB, being difficult to control due to their high-risk behaviours. Strengthening of HIV transmission prevention strategies, particularly in identified risk groups, is mandatory.
在过去几年中，我们观察到新诊断出的同时感染肝炎病毒或严重细菌感染的艾滋病毒感染静脉注射吸毒者（IDU）数量惊人地增加。我们研究的目的是评估诊断为艾滋病毒、丙型肝炎病毒（HCV）和结核病（TB）的IDU的发病率、人口统计学和临床特征。
对2009年1月至2014年4月在单一中心收治的合并HCV和TB的艾滋病毒感染IDU进行前瞻性研究。将数据与一组未感染TB的艾滋病毒感染IDU进行比较。使用Graphpad Prism 4.01进行统计分析。
在450名艾滋病毒感染IDU中，134名（29.7%）被诊断为感染艾滋病毒、HCV和TB。IDU中的TB发病率从2009年的0%上升至2013年的30.2%。合并TB感染的患者诊断时的平均年龄为30岁[15 - 56岁]；大多数为男性，106名（84.4%）；来自城市地区，120名（89.5%）；与未感染TB的患者相比，其教育水平显著更低（85%对68.3%，p<0.0001），失业率更高（80%对55%，p<0.0001）。TB感染的IDU与未感染TB的IDU相比，CD4细胞计数中位数更低（143对472/mm³，p<0.0001）。与未感染TB的患者相比，感染TB的IDU往往更频繁地出现延迟就诊情况（59.7对24.6，p<0.0001），且患有晚期艾滋病毒疾病的比例更高（47.7%对7.59%，p<0.0001）。64名（47.7%）患者的TB培养呈阳性，3名（2.2%）患有耐多药TB，2名（1.5%）患有广泛耐药。51名患者（38%）被诊断为播散性和/或肺外TB。与未感染TB的IDU相比，TB患者的总体死亡率更高（19.4%对8.2%，p = 0.0007），播散性TB与最严重的免疫抑制（CD4细胞计数中位数42/mm³）和最高死亡率（27.4%）相关。
艾滋病毒/HCV合并感染的IDU中TB的发病率很高且随时间上升。严重免疫抑制患者中TB感染更常见，播散性和/或肺外疾病的IDU死亡率更高。IDU是感染和传播艾滋病毒、病毒性肝炎和TB的重要候选人群，因其高危行为难以控制。必须加强艾滋病毒传播预防策略，特别是在已确定的高危人群中。
