Baghaei Parvaneh, Tabarsi Payam, Jabehdari Syna, Marjani Majid, Moniri Afshin, Farnia Parissa, Velayati Ali Akbar
Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Int J Mycobacteriol. 2016 Dec;5 Suppl 1:S16-S17. doi: 10.1016/j.ijmyco.2016.10.010. Epub 2016 Oct 27.
OBJECTIVE/BACKGROUND: The risk of mortality and morbidity among tuberculosis (TB) and human immunodeficiency virus (HIV) coinfected patients is significantly higher than that of patients infected with TB alone. The aim of this study was to evaluate the survival of TB-HIV patients in a TB-referral center during a 10-year follow-up.
All TB-HIV patients in our referral center were enrolled in the study from 2003 to 2014, and patients were divided into two groups: HIV-TB patients without a history of TB treatment (new cases of TB) and HIV-TB patients with a history of TB treatment. Both groups were treated based on World Health Organization TB-treatment guidelines, and multivariate analysis was performed to evaluate risk factors of all-cause mortality.
During the study, 22 HIV-TB patients with a history of TB treatment and 263 HIV-TB patients with newly diagnosed TB were included. Baseline demographic and clinical characteristics were similar, except that miliary TB (98% vs. 2%) and mortality (97% vs. 3%; p=0.06) were more likely in HIV patients with newly diagnosed TB. During TB treatment and subsequent follow-up, two patients did not respond to treatment and 92 (32.3%) patients died, whereas the cure rate was 60%. Pneumothorax [hazard ratio (HR): 3.17], coinfection (herpes zoster, toxoplasmosis, cytomegalovirus infection, Pneumocystis jiroveci, candidiasis, and other opportunistic infection; HR: 1.75), CD4<100cells/mL (HR: 1.96), thrombocytopenia (HR: 2.29), and lack of treatment with antiretroviral agents (ART; HR: 2.82) were significantly associated with all-cause mortality according to multivariate analysis.
Our retrospective review of coinfected TB-HIV patients hospitalized in Tehran showed that the management and monitoring of coinfection, pneumothorax and other adverse effects, as well as early initiation of ART, improved patient survival.
目的/背景：结核病（TB）与人类免疫缺陷病毒（HIV）合并感染患者的死亡和发病风险显著高于单纯感染结核病的患者。本研究的目的是评估一家结核病转诊中心的TB-HIV患者在10年随访期间的生存情况。
2003年至2014年，我们转诊中心的所有TB-HIV患者均纳入本研究，患者分为两组：无结核病治疗史的HIV-TB患者（结核病新发病例）和有结核病治疗史的HIV-TB患者。两组均根据世界卫生组织结核病治疗指南进行治疗，并进行多变量分析以评估全因死亡率的危险因素。
研究期间，纳入了22例有结核病治疗史的HIV-TB患者和263例新诊断为结核病的HIV-TB患者。除粟粒性结核病（98%对2%）和死亡率（97%对3%；p=0.06）在新诊断为结核病的HIV患者中更常见外，基线人口统计学和临床特征相似。在结核病治疗及随后的随访期间，2例患者治疗无反应，92例（32.3%）患者死亡，治愈率为60%。根据多变量分析，气胸[风险比（HR）：3.17]、合并感染（带状疱疹、弓形虫病、巨细胞病毒感染、耶氏肺孢子菌、念珠菌病和其他机会性感染；HR：1.75）、CD4<100细胞/mL（HR：1.96）、血小板减少症（HR：2.29）以及未接受抗逆转录病毒药物（ART）治疗（HR：2.82）与全因死亡率显著相关。
我们对在德黑兰住院的TB-HIV合并感染患者的回顾性研究表明，对合并感染、气胸和其他不良反应的管理与监测，以及早期启动ART可提高患者生存率。
