Rubaihayo John, Tumwesigye Nazarius M, Konde-Lule Joseph
Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda ; Department of Public Health, School of Health Sciences, Mountains of the Moon University, Fort Portal, Uganda.
Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.
AIDS Res Ther. 2015 Jun 13;12:20. doi: 10.1186/s12981-015-0060-0. eCollection 2015.
Trends in prevalence of opportunistic infections (OIs) associated with the human immunodeficiency virus (HIV) in resource poor settings have previously not been well documented. The objective of this study was to describe the trends in prevalence of Diarrhoea, Bacterial pneumonia, Kaposi's sarcoma, Malaria and Geohelminths among HIV positive individuals over a 12 year period in Uganda.
Observation data for 5972 HIV positive individuals enrolled with the AIDS support organisation (TASO) in Uganda were analysed. Study participants were drawn from three HIV clinics located in different geographical areas of Uganda and followed from January 2002 to December 2013. The prevalence trends for the above OIs were plotted using the Box Jenkins moving average technique. X (2)-test for trend was used to test for the significance of the trends and Pearson's correlation coefficient used to test for the strength of linear relationship between OI prevalence and calendar time. Mixed effect linear regression was used to estimate average monthly change in prevalence with monthly variation modelled as a random effect.
A total of 204,871 monthly medical reports were retrieved and analysed. 73 % (4301/5972) were female with a median age of 32 years (inter-quartile range 26-39). Overall, significant decreasing mean annual prevalence trends (p < 0.05, X(2) trend) were observed for Diarrhoea (<1 month) with Pearson's correlation coefficient (r = -0.89), Malaria (r = -0.75), Bacterial Pneumonia (r = -0.52), and Geohelminth (r = -0.32). Non-significant increasing mean annual prevalence trend was observed for Kaposis sarcoma (p = 0.20, X(2) trend; r = +0.26). After adjusting for age, sex and clinic in a mixed effects linear regression model, average monthly prevalence declined significantly at a rate of 0.4 % for Kaposis sarcoma, 0.3 % for Geohelminths, 2 % for Malaria, 1 % for Bacterial Pneumonia and 3 % for Diarrhoea(<1 month). However, the rate of decline per month differed significantly (p < 0.05) by HIV clinic for Diarrhoea (<1 month), and age, sex and clinic for malaria.
Overall, decreasing trends were observed in the above OIs. However the trends differed significantly by OI, geographical location and demographic characteristics. There is urgent need to integrate interventions targeting malaria and geohelminths in HIV programmes.
此前资源匮乏地区与人类免疫缺陷病毒（HIV）相关的机会性感染（OIs）患病率趋势尚未得到充分记录。本研究的目的是描述乌干达12年间HIV阳性个体中腹泻、细菌性肺炎、卡波西肉瘤、疟疾和土源性蠕虫感染的患病率趋势。
分析了乌干达艾滋病支持组织（TASO）登记的5972名HIV阳性个体的观察数据。研究参与者来自乌干达不同地理区域的三家HIV诊所，随访时间为2002年1月至2013年12月。使用Box Jenkins移动平均技术绘制上述机会性感染的患病率趋势图。采用趋势χ²检验来检验趋势的显著性，并用Pearson相关系数检验机会性感染患病率与日历时间之间线性关系的强度。采用混合效应线性回归估计患病率的平均每月变化，将每月变化建模为随机效应。
共检索并分析了204,871份月度医疗报告。73%（4301/5972）为女性，中位年龄为32岁（四分位间距26 - 39岁）。总体而言，腹泻（<1个月）、疟疾、细菌性肺炎和土源性蠕虫感染的年平均患病率呈显著下降趋势（P < 0.05，趋势χ²检验），Pearson相关系数分别为（r = -0.89）、（r = -0.75）、（r = -0.52）和（r = -0.32）。卡波西肉瘤的年平均患病率呈非显著上升趋势（P = 0.20，趋势χ²检验；r = +0.26）。在混合效应线性回归模型中对年龄、性别和诊所进行调整后，卡波西肉瘤的平均每月患病率显著下降，下降率为0.4%，土源性蠕虫感染为0.3%，疟疾为2%，细菌性肺炎为1%，腹泻（<1个月）为3%。然而，腹泻（<1个月）在不同HIV诊所的每月下降率差异显著（P < 0.05），疟疾在年龄、性别和诊所方面也存在显著差异。
总体而言，上述机会性感染呈下降趋势。然而，不同机会性感染、地理位置和人口统计学特征的趋势差异显著。迫切需要将针对疟疾和土源性蠕虫感染的干预措施纳入HIV项目。
