Maniewski Ula, Payen Marie-Christine, Delforge Marc, De Wit Stephane
a Division of Infectious Diseases, St Pierre Hospital , Université Libre de Bruxelles , Brussels , Belgium.
Acta Clin Belg. 2017 Aug;72(4):238-241. doi: 10.1080/17843286.2016.1237696. Epub 2016 Sep 30.
A decreasing incidence of tuberculosis (TB) among HIV patients has been documented in high-income settings and screening for tuberculosis is not systematically performed in many clinics (such as ours). Our objectives are to evaluate whether a same decline of incidence was seen in our Belgian tertiary center and to evaluate whether systematic screening and prophylaxis of tuberculosis should remain part of routine practice.
Between 2005 and 2012, the annual incidence of tuberculosis among adult HIV patients was measured. The impact of demographic characteristics and CD nadir on the incidence of active TB was evaluated.
Among the 1167 patients who entered the cohort, 42 developed active TB with a significant decrease of annual incidence from 28/1000 patient-years in 2005 to 3/1000 patient-years in 2012. Among the 42 cases, 83% were of sub-Saharan origin. Median CD4 cell count upon HIV diagnosis was significantly lower in TB cases and 60% had a nadir CD4 below 200/μl. Thirty-six percent of incident TB occurred within 14 days after HIV diagnosis.
A significant decline of TB incidence in HIV patients was observed. Incident TB occurred mainly in African patients, with low CD4 upon HIV diagnosis. A significant proportion of TB cases were discovered early in follow-up which probably reflects TB already present upon HIV diagnosis. In a low endemic setting, exclusion of active TB upon HIV diagnosis remains a priority and screening for LTBI should focus on HIV patients from high risk groups such as migrants from endemic regions, especially in patients with low CD4 nadir.
在高收入地区，已有文献记载HIV患者中结核病（TB）发病率呈下降趋势，且许多诊所（如我们的诊所）并未系统地开展结核病筛查。我们的目的是评估在比利时的三级医疗中心是否也出现了相同的发病率下降情况，并评估结核病的系统筛查和预防是否应继续作为常规诊疗的一部分。
对2005年至2012年期间成年HIV患者的结核病年发病率进行测量。评估人口统计学特征和CD4最低点对活动性结核病发病率的影响。
在纳入队列的1167名患者中，42人发生了活动性结核病，年发病率从2005年的28/1000患者年显著下降至2012年的3/1000患者年。在这42例病例中，83%来自撒哈拉以南地区。结核病病例在HIV诊断时的CD4细胞计数中位数显著更低，60%的患者CD4最低点低于200/μl。36%的新发结核病发生在HIV诊断后的14天内。
观察到HIV患者中结核病发病率显著下降。新发结核病主要发生在非洲患者中，他们在HIV诊断时CD4水平较低。相当一部分结核病病例在随访早期被发现，这可能反映出在HIV诊断时结核病就已存在。在低流行地区，HIV诊断时排除活动性结核病仍然是首要任务，对潜伏性结核感染的筛查应重点关注来自高风险群体的HIV患者，如来自流行地区的移民，尤其是CD4最低点较低的患者。
