Kufa Tendesayi, Chihota Violet, Mngomezulu Victor, Charalambous Salome, Verver Suzanne, Churchyard Gavin, Borgdorff Martien
The Aurum Institute, 29 Queens Road, Parktown, Johannesburg, 2193, South Africa.
The School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
BMC Infect Dis. 2016 Jun 10;16:266. doi: 10.1186/s12879-016-1598-8.
Intensified case finding (ICF) and earlier antiretroviral therapy (ART) initiation are strategies to reduce burden of HIV-associated tuberculosis (TB). We describe incidence of and associated factors for TB among HIV-positive individuals with CD4 counts > 350 cells/μl in South Africa.
Prospective cohort study of individuals recruited for a TB vaccine trial. Eligible individuals without prevalent TB were followed up at 6 and 12 months after enrolment. Cox proportional hazards regression was used to determine factors associated with risk of incident TB.
Six hundred thirty-four individuals were included in the analysis [80.9 % female, 57.9 % on ART, median CD4 count 562 cells/μl (IQR 466-694 cells/μl)]. TB incidence was 2.7 per 100 person-years (pyrs) (95 % CI 1.6-4.4 per 100 pyrs) and did not differ significantly between those on ART and those not on ART [HR 0.65 (95 % CI 0.24-1.81)]. Low body mass index (BMI <18.5 kg/m(2)) was associated with incident TB [HR 3.87 (95 % CI 1.09-13.73)]. Half of the cases occurred in the first 6 months of follow up and may have been prevalent or incubating cases at enrolment.
TB incidence was high and associated with low BMI. Intensified case finding for TB should be strengthened for all HIV positive individuals regardless of their CD4 count or ART status.
强化病例发现（ICF）和更早开始抗逆转录病毒治疗（ART）是减轻HIV相关结核病（TB）负担的策略。我们描述了南非CD4细胞计数>350个/μl的HIV阳性个体中结核病的发病率及相关因素。
对招募参加结核病疫苗试验的个体进行前瞻性队列研究。符合条件且无现患结核病的个体在入组后6个月和12个月进行随访。采用Cox比例风险回归确定与结核病发病风险相关的因素。
634名个体纳入分析[女性占80.9%，57.9%接受ART，CD4细胞计数中位数为562个/μl（四分位间距466 - 694个/μl）]。结核病发病率为每100人年2.7例（95%CI每100人年1.6 - 4.4例），接受ART者与未接受ART者之间无显著差异[风险比（HR）0.65（95%CI 0.24 - 1.81）]。低体重指数（BMI<18.5 kg/m²）与结核病发病相关[HR 3.87（95%CI 1.09 - 13.73）]。一半的病例发生在随访的前6个月，可能在入组时即为现患或潜伏病例。
结核病发病率高且与低BMI相关。对于所有HIV阳性个体，无论其CD4细胞计数或ART状态如何，都应加强结核病的强化病例发现。
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