Bachmann Max O, Timmerman Venessa, Fairall Lara R
aNorwich Medical School, University of East Anglia, Norwich, UK bKnowledge Translation Unit, Lung Institute, Medical School, University of Cape Town, Cape Town, South Africa.
AIDS. 2015 Nov;29(17):2261-8. doi: 10.1097/QAD.0000000000000806.
The objective of this study is to estimate the effectiveness of antiretroviral treatment (ART) in preventing tuberculosis (TB) in HIV-infected people during the first 6 years of ART programme expansion.
A cohort study comparing TB risk without ART and after ART initiation.
Public sector HIV programme of the Free State province, South Africa.
Seventy-four thousand and seventy-four HIV-infected people enrolled from 2004 until 2010, of whom 43 898 received ART and 30 176 did not.
Combination ART.
Time to first TB diagnosis, adjusted for CD4 cell count, weight, age, sex, previous TB, district and year, with ART, CD4 cell count and weight as time-varying covariates and with death as a competing risk.
Three thousand eight hundred and fifty-eight first TB episodes occurred during 78 202 person-years at risk with ART and 5669 episodes occurred during 62 801 person-years without ART [incidence rates 4.9 and 9.0 per 100 person-years, crude incidence rate ratio 0.55 (95% confidence interval 0.52-0.57)]. The adjusted subhazard ratio (SHR) of time to first TB episode after starting ART, compared with follow-up without ART, was 0.67 (0.64-0.70). Within CD4 cell count subgroups (<50, 50-199, 100-199, 200-349 and >350 cells/μl), the respective SHRs were 0.64 (0.57-0.71), 0.63 (0.57-0.70), 0.66 (0.61-0.72), 0.67 (0.62-0.72), 0.72 (0.63-0.83) and 0.97 (0.60-1.59). Adjusted SHRs for ART decreased with each year of enrolment, from 0.90 (0.77-1.04) in 2004 to 0.54 (0.43-0.67) in 2010.
ART was effective in preventing TB in HIV-infected patients with CD4 cell counts below 350 cells/μl, but less so than previously estimated. Effectiveness increased each year.
本研究的目的是评估在抗逆转录病毒治疗（ART）项目扩大的头6年中，ART在预防HIV感染者患结核病（TB）方面的效果。
一项队列研究，比较未接受ART和开始ART后的结核病风险。
南非自由邦省的公共部门HIV项目。
2004年至2010年登记的74074名HIV感染者，其中43898人接受了ART，30176人未接受。
联合ART。
首次结核病诊断时间，根据CD4细胞计数、体重、年龄、性别、既往结核病、地区和年份进行调整，将ART、CD4细胞计数和体重作为随时间变化的协变量，并将死亡作为竞争风险。
在接受ART的78202人年的危险时间内发生了3858例首次结核病发作，在未接受ART的62801人年的危险时间内发生了5669例发作[发病率分别为每100人年4.9例和9.0例，粗发病率比为0.55（95%置信区间0.52 - 0.57）]。与未接受ART的随访相比，开始ART后首次结核病发作时间的调整后亚危险比（SHR）为0.67（0.64 - 0.70）。在CD4细胞计数亚组（<50、50 - 199、100 - 199、200 - 349和>350个细胞/μl）中，各自的SHR分别为0.64（0.57 - 0.71）、0.63（0.57 - 0.70）、0.66（0.61 - 0.72）、0.67（0.62 - 0.72）、0.72（0.63 - 0.83）和0.97（0.60 - 1.59）。ART的调整后SHR随着每年的入组而降低，从2004年的0.90（0.77 - 1.04）降至2010年的0.54（0.43 - 0.67）。
ART在预防CD4细胞计数低于350个细胞/μl的HIV感染患者患结核病方面有效，但效果低于先前估计。有效性逐年提高。
