HIV Unit , University of Geneva Hospitals , Geneva , Switzerland ; Médecins Sans Frontières , Geneva , Switzerland.
Médecins Sans Frontières , Geneva , Switzerland.
Open Forum Infect Dis. 2014 May 21;1(1):ofu021. doi: 10.1093/ofid/ofu021. eCollection 2014 Mar.
Buruli ulcer is the third most common mycobacterial disease after tuberculosis and leprosy and is particularly frequent in rural West and Central Africa. However, the impact of HIV infection on BU severity and prevalence remains unclear.
This was a retrospective study of data collected at the Akonolinga District Hospital, Cameroon, from January 1, 2002 to March 27, 2013. Human immunodeficiency virus prevalence among BU patients was compared with regional HIV prevalence. Baseline characteristics of BU patients were compared between HIV-negative and HIV-positive patients and according to CD4 cell count strata in the latter group. Buruli ulcer time-to-healing was assessed in different CD4 count strata, and factors associated with BU main lesion size at baseline were identified.
Human immunodeficiency virus prevalence among BU patients was significantly higher than the regional estimated prevalence in each group (children, 4.00% vs 0.68% [P < .001]; men, 17.0% vs 4.7% [P < .001]; women, 36.0% vs 8.0% [P < .001]). Individuals who were HIV positive had a more severe form of BU, with an increased severity in those with a higher level of immunosuppression. Low CD4 cell count was significantly associated with a larger main lesion size (β-coefficient, -0.50; P = .015; 95% confidence interval [CI], -0.91-0.10). Buruli ulcer time-to-healing was more than double in patients with a CD4 cell count below 500 cell/mm(3) (hazard ratio, 2.39; P = .001; 95% CI, 1.44-3.98).
Patients who are HIV positive are at higher risk for BU. Human immunodeficiency virus-induced immunosuppression seems to have an impact on BU clinical presentation and disease evolution.
溃疡分枝杆菌病是继肺结核和麻风病之后的第三大常见分枝杆菌病，尤其在西非和中非的农村地区较为常见。然而，HIV 感染对溃疡分枝杆菌病严重程度和流行率的影响尚不清楚。
这是一项回顾性研究，数据来自喀麦隆阿科诺林加区医院 2002 年 1 月 1 日至 2013 年 3 月 27 日的资料。溃疡分枝杆菌病患者中的人类免疫缺陷病毒流行率与该地区估计的 HIV 流行率进行了比较。将 HIV 阴性和 HIV 阳性患者的溃疡分枝杆菌病患者的基线特征进行了比较，并根据后者的 CD4 细胞计数分层进行了比较。评估了不同 CD4 计数分层的溃疡分枝杆菌病愈合时间，并确定了与基线时溃疡主要病变大小相关的因素。
溃疡分枝杆菌病患者中的 HIV 流行率明显高于各分组中的地区估计流行率（儿童，4.00%比 0.68%[P<0.001]；男性，17.0%比 4.7%[P<0.001]；女性，36.0%比 8.0%[P<0.001]）。HIV 阳性个体的溃疡分枝杆菌病更严重，免疫抑制程度越高，病情越严重。低 CD4 细胞计数与较大的主要病变大小显著相关（β 系数，-0.50；P=0.015；95%置信区间[CI]，-0.91 至 0.10）。CD4 细胞计数低于 500 个细胞/mm3的患者溃疡分枝杆菌病愈合时间超过两倍（风险比，2.39；P=0.001；95%CI，1.44 至 3.98）。
HIV 阳性患者患溃疡分枝杆菌病的风险更高。HIV 诱导的免疫抑制似乎对溃疡分枝杆菌病的临床表现和疾病进展有影响。
