Bronner Murrison Liza, Martinson Neil, Moloney Rachael M, Msandiwa Regina, Mashabela Mondiwana, Samet Jonathan M, Golub Jonathan E
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
Center for Tuberculosis Research, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America.
PLoS One. 2016 Nov 28;11(11):e0167133. doi: 10.1371/journal.pone.0167133. eCollection 2016.
Although there is ample evidence that smoking increases the risk of tuberculosis (TB), the magnitude of impact on TB risk among HIV-infected persons is poorly described. Given that a high proportion of patients with TB are co-infected with HIV in South Africa, the risks arising from the intersection of smoking, TB, and HIV/AIDS have key relevance for tobacco control policies.
To evaluate the association of pulmonary tuberculosis (PTB) with current tobacco smoking among men with HIV in South Africa.
Case-control study of antiretroviral therapy naïve men with confirmed HIV-infection in Johannesburg. Cases had laboratory-confirmed PTB and controls had no evidence of active TB. Participants were interviewed to collect detailed smoking histories.
We enrolled 146 men diagnosed with PTB and 133 controls. Overall, 33% of participants were currently smoking, defined as smoking a cigarette within 2 months (34% cases vs. 32% controls, p = 0.27). Median CD4 count was lower (60 vs. 81 cells/mm3, P = 0.03) and median viral load was higher (173 vs. 67 copies/ul per thousand, P<0.001) among cases versus controls. In adjusted analyses, current smoking tripled the odds of PTB (aOR 3.2; 95%CI: 1.3-7.9, P = 0.01) and former smoking nearly doubled the odds of PTB (aOR 1.8; 95%CI 0.8-4.4, P = 0.18) compared to never smoking.
Males with HIV that smoke are at greater odds for developing PTB than non-smokers. Extensive smoking cessation programs are needed to reduce odds of TB and promote health among adults living with HIV.
尽管有充分证据表明吸烟会增加患肺结核（TB）的风险，但吸烟对艾滋病毒感染者患结核病风险的影响程度却鲜有描述。鉴于南非很大一部分结核病患者同时感染了艾滋病毒，吸烟、结核病和艾滋病毒/艾滋病相互作用所产生的风险对于烟草控制政策具有关键意义。
评估南非艾滋病毒感染男性中肺结核（PTB）与当前吸烟之间的关联。
对约翰内斯堡未接受过抗逆转录病毒治疗且确诊感染艾滋病毒的男性进行病例对照研究。病例为实验室确诊的PTB患者，对照者无活动性结核病证据。对参与者进行访谈以收集详细的吸烟史。
我们招募了146名被诊断为PTB的男性和133名对照者。总体而言，33%的参与者目前吸烟，定义为在2个月内吸过烟（病例组为34%，对照组为32%，p = 0.27）。与对照组相比，病例组的CD4细胞计数中位数较低（60对81个细胞/mm³，P = 0.03），病毒载量中位数较高（173对67拷贝/ul每千，P<0.001）。在多因素分析中，与从不吸烟相比，当前吸烟使患PTB的几率增加两倍（调整后比值比[aOR] 3.2；95%置信区间[CI]：1.3 - 7.9，P = 0.01），既往吸烟使患PTB的几率增加近一倍（aOR 1.8；95%CI 0.8 - 4.4，P = 0.18）。
感染艾滋病毒的吸烟男性患PTB的几率高于不吸烟者。需要开展广泛的戒烟项目以降低结核病发病几率，并促进艾滋病毒感染者的健康。
