在印度一家私人诊所寻求治疗的艾滋病毒感染患者中，每日抗结核治疗的效果。

Treatment outcomes of daily anti-tuberculosis treatment in HIV-infected patients seeking care at a private clinic in India.

作者信息

Parchure R, Kulkarni V, Gangakhedkar R, Swaminathan S

机构信息

Prayas, Pune, India.

National AIDS Research Institute, Pune, India; Indian Council of Medical Research, New Delhi, India.

出版信息

Int J Tuberc Lung Dis. 2016 Oct;20(10):1348-1353. doi: 10.5588/ijtld.16.0098.

DOI:10.5588/ijtld.16.0098

PMID:27725046

Abstract

SETTING

Little is known about outcomes of patients co-infected with human immunodeficiency virus (HIV) and tuberculosis (TB) who are treated in the private sector in India.

OBJECTIVE

To describe the treatment outcomes of daily anti-tuberculosis treatment (ATT) and their determinants among HIV-TB co-infected patients treated at a private clinic in Pune, India.

DESIGN

Data on adult HIV-TB co-infected patients treated with daily ATT were analysed using logistic regression and Cox model to assess risk factors for default and death.

RESULTS

Of 769 cases, 78% were aged <45 years, 71% were males, 64% had CD4 < 200 cells/mm, 67% were antiretroviral treatment (ART) naïve at TB diagnosis, 53% had extra-pulmonary TB, and 12% had a past history of TB. ATT was successfully completed by 58.5%, 34.3% defaulted (i.e., discontinued ATT for >2 months) and 3.9% died during ATT. The risk of default was higher among males (aOR 1.67, 95%CI 1.17-2.39), ART-naïve patients (aOR 1.91, 95%CI 1.34-2.73) and those with a past history of TB (aOR 1.86, 95%CI 1.15-3.01). Survival probability at 365 days was 95% (95%CI 93-97). The risk of death was higher among patients with CD4 < 50 cells/mm (aHR 4.63, 95%CI 1.47-14.65) than in those with CD4 > 200 cells/mm.

CONCLUSIONS

Low overall mortality was seen with daily ATT in HIV-TB co-infected patients. High default rates in private facilities warrant urgent attention.

摘要

背景

在印度私立部门接受治疗的同时感染人类免疫缺陷病毒（HIV）和结核病（TB）的患者的治疗结果鲜为人知。

目的

描述在印度浦那一家私立诊所接受治疗的HIV-TB合并感染患者每日抗结核治疗（ATT）的治疗结果及其决定因素。

设计

使用逻辑回归和Cox模型分析接受每日ATT治疗的成年HIV-TB合并感染患者的数据，以评估违约和死亡的风险因素。

结果

在769例病例中，78%年龄小于45岁，71%为男性，64%的CD4细胞计数<200个/立方毫米，67%在结核病诊断时未接受抗逆转录病毒治疗（ART），53%患有肺外结核，12%有结核病既往史。58.5%的患者成功完成了ATT，34.3%的患者违约（即中断ATT超过2个月），3.9%的患者在ATT期间死亡。男性（调整后比值比[aOR]1.67，95%置信区间[CI]1.17-2.39）、未接受ART治疗的患者（aOR 1.91，95%CI 1.34-2.73）和有结核病既往史的患者（aOR 1.86，95%CI 1.15-3.01）违约风险更高。365天时的生存概率为95%（95%CI 93-97）。CD4细胞计数<50个/立方毫米的患者死亡风险（调整后风险比[aHR]4.63，95%CI 1.47-14.65）高于CD4细胞计数>200个/立方毫米的患者。