Division of Medicine, University College London, London, UK; HIV/STI Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK.
HIV/STI Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK.
Lancet HIV. 2015 Jun;2(6):e243-51. doi: 10.1016/S2352-3018(15)00063-6. Epub 2015 May 17.
Whether the incidence of tuberculosis in HIV-positive people receiving long-term antiretroviral therapy (ART) remains above background population rates is unclear. We compared tuberculosis incidence in people receiving ART with background rates in England, Wales, and Northern Ireland.
We analysed a national cohort of HIV-positive individuals linked to the national tuberculosis register. Tuberculosis incidence in the HIV-positive cohort (2007-11) was stratified by ethnic origin and time on ART and compared with background rates (2009). Ethnic groups were defined as follows: the black African group included all individuals of black African origin, including those born in the UK and overseas; the white ethnic group included all white individuals born in the UK and overseas; the south Asian group included those of Indian, Pakistani, and Bangladeshi origin, born in the UK and overseas; and the other ethnic group included all other ethnic origins, including black Afro-Caribbeans.
The HIV-positive cohort comprised 79 919 individuals, in whom there were 1550 incident cases in 231 664 person-years of observation (incidence 6·7 cases per 1000 person-years). Incidence of tuberculosis in the HIV-positive cohort was 13·6 per 1000 person-years in black Africans and 1·7 per 1000 person-years in white individuals. Incidence of tuberculosis during long-term ART (≥5 years) in black Africans with HIV was 2·4 per 1000 person-years, similar to background rates of 1·9 per 1000 person-years in this group (rate ratio 1·2, 95% CI 0·96-1·6; p=0·083); but in white individuals with HIV on long-term ART the incidence of 0·5 per 1000 person-years was higher than the background rate of 0·04 per 1000 person-years (rate ratio 14·5, 9·4-21·3; p<0·0001). The increased incidence relative to background in white HIV-positive individuals persisted when analysis was restricted to person-time accrued on ART with CD4 counts of at least 500 cells per μL and when white HIV-positive individuals born abroad were excluded.
Tuberculosis incidence is unacceptably high irrespective of HIV status in black Africans. In white individuals with HIV, tuberculosis incidence is significantly higher than background rates in white people despite long-term ART. Expanded testing and treatment for latent tuberculosis infection to all HIV-infected adults, irrespective of ART status and CD4 cell count, might be warranted.
Public Health England.
在接受长期抗逆转录病毒治疗（ART）的 HIV 阳性人群中，结核病的发病率是否仍高于背景人群的发病率尚不清楚。我们比较了接受 ART 的人群与英格兰、威尔士和北爱尔兰的背景发病率。
我们分析了一个与国家结核病登记处相关联的全国性 HIV 阳性人群队列。根据种族和 ART 时间对 HIV 阳性队列（2007-11 年）中的结核病发病率进行分层，并与背景发病率（2009 年）进行比较。种族群体定义如下：黑人非洲群体包括所有黑人非洲血统的个体，包括在英国和海外出生的个体；白人种族群体包括所有在英国和海外出生的白人个体；南亚群体包括印度、巴基斯坦和孟加拉国血统的个体，在英国和海外出生；其他种族群体包括所有其他种族起源，包括黑人加勒比裔。
HIV 阳性队列包括 79919 人，在 231664 人年的观察期间，有 1550 例新发病例（发病率为每 1000 人年 6.7 例）。HIV 阳性队列中，黑人非洲裔的结核病发病率为每 1000 人年 13.6 例，白种人的发病率为每 1000 人年 1.7 例。黑人非洲裔 HIV 阳性患者长期接受 ART（≥5 年）期间的结核病发病率为每 1000 人年 2.4 例，与该人群的背景发病率 1.9 例/1000 人年相似（比率 1.2，95%CI 0.96-1.6；p=0.083）；但在长期接受 ART 的白人 HIV 阳性个体中，发病率为每 1000 人年 0.5 例，高于背景发病率每 1000 人年 0.04 例（比率 14.5，9.4-21.3；p<0.0001）。当分析仅限于 CD4 计数至少为 500 个细胞/μL 的 ART 累计人时，以及当排除出生在国外的白人 HIV 阳性个体时，白人 HIV 阳性个体与背景相比发病率的增加仍然存在。
无论 HIV 状态如何，黑人非洲裔的结核病发病率都高得令人无法接受。在白人 HIV 阳性个体中，尽管接受了长期 ART，但结核病的发病率明显高于白人的背景发病率。对所有 HIV 感染者，无论 ART 状况和 CD4 细胞计数如何，扩大潜伏性结核病感染的检测和治疗可能是必要的。
英国公共卫生署。
