Diendéré Eric Arnaud, Badoum Gisele, Bognounou René, Guira Oumar, Ilboudo Leonce, Tieno Herve, Diallo Ismael, Drabo Joseph
a Internal Medicine Department , Teaching Hospital Yalgado Ouédraogo , Ouagadougou , Burkina Faso.
b Pneumophtisiology Department , Teaching Hospital Yalgado Ouedraogo , Ouagadougou , Burkina Faso.
AIDS Care. 2015;27(10):1250-4. doi: 10.1080/09540121.2015.1050982. Epub 2015 Aug 20.
Tuberculosis is the leading cause of death among people living with HIV/AIDS (PLHIV) in sub-Saharan Africa. In PLHIV, Smear-Negative Pulmonary Tuberculosis (SNPTB) and Extrapulmonary Tuberculosis (EPTB) are predominant. Presumptive anti-tuberculosis (anti-TB) treatment is often delayed leading to a high mortality rate.
To investigate the clinical outcomes of presumptive anti-TB treatment in HIV patients suspected of having TB and to determine the factors associated with patients' death.
We conducted a retrospective descriptive study from 1 January 2007 to 31 December 2008 in the Department of Internal Medicine of the Hospital Yalgado Ouédraogo on patients infected with HIV who received a presumptive anti-TB treatment. Defining patients with SNPTB or EPTB was based on the 2007 WHO's diagnostic algorithm of SNPTB and EPTB.
One hundred and sixteen patients of the 383 (30.2%) HIV patients hospitalized in this period were suspected of having TB. The average CD4 count was 86.1 cells/µl (SD = 42.3). A SNPTB was diagnosed in 67 patients (57.8%) and a EPTB in 49 patients (42.2%). The median length of hospitalization duration was 23.5 days. The average time of initiation of anti-TB treatment after admission was 22 days (SD = 9.2 days). Evolution during the hospital stay was favorable for 65 patients (56.0%), unfavorable for 48 patients (41.4% or 12.5% of all hospitalized patients), and 3 patients (2.6%) were treatment defaulters. In a multivariate analysis, hospitalization duration longer than 15 days and a delay of anti-TB treatment initiation of more than 30 days are independent factors associated with patients' deaths.
An urgent access to TB-diagnostic tools and a revision of the International algorithm for the diagnosis and treatment of SNPTB and EPTB in the context of HIV could help to reduce the delay of anti-TB treatment initiation and the mortality rate of PLHIV in sub-Saharan Africa.
在撒哈拉以南非洲地区，结核病是艾滋病毒/艾滋病患者（PLHIV）的主要死因。在PLHIV中，涂片阴性肺结核（SNPTB）和肺外结核（EPTB）较为常见。推定抗结核治疗往往延迟，导致死亡率很高。
调查疑似患有结核病的艾滋病毒患者推定抗结核治疗的临床结果，并确定与患者死亡相关的因素。
我们于2007年1月1日至2008年12月31日在亚尔加杜·韦德拉奥戈医院内科对接受推定抗结核治疗的艾滋病毒感染患者进行了一项回顾性描述性研究。根据2007年世界卫生组织的SNPTB和EPTB诊断算法来定义SNPTB或EPTB患者。
在此期间住院的383名艾滋病毒患者中有116名（30.2%）疑似患有结核病。平均CD4细胞计数为86.1个/微升（标准差=42.3）。67名患者（57.8%）被诊断为SNPTB，49名患者（42.2%）被诊断为EPTB。住院时间中位数为23.5天。入院后开始抗结核治疗的平均时间为22天（标准差=9.2天）。65名患者（56.0%）住院期间病情好转，48名患者（41.4%，占所有住院患者的12.5%）病情不佳，3名患者（2.6%）治疗中断。在多变量分析中，住院时间超过15天以及抗结核治疗开始延迟超过30天是与患者死亡相关的独立因素。
在艾滋病毒背景下，尽快获得结核病诊断工具并修订SNPTB和EPTB的国际诊断和治疗算法，可能有助于减少抗结核治疗开始的延迟以及撒哈拉以南非洲地区PLHIV的死亡率。
