Institut de Recherche Pour le Développement, Unité Mixte Internationale 174-Program for HIV Prevention and Treatment, Marseille, France.
Faculty of Associated Medical Sciences, Chiang Mai University, Thailand.
J Pediatric Infect Dis Soc. 2017 Jun 1;6(2):161-167. doi: 10.1093/jpids/piw090.
BACKGROUND.: We assessed the incidence of tuberculosis, risk factors for tuberculosis, and the contribution of tuberculosis on mortality in a large cohort of human immunodeficiency virus (HIV)-infected children <15 years of age initiating first-line antiretroviral therapy (ART) between 1999 and 2012 in Thailand, one of the 22 high tuberculosis burden countries.
METHODS.: A physician reviewed and classified tuberculosis cases. Incidence was the number of children with incident tuberculosis, defined as a first or recurrent tuberculosis diagnosis >30 days after ART initiation, divided by the total person-years of follow-up (PYFU). Risk factors for incident tuberculosis were identified using Fine and Gray's competing risks models, with death from other causes treated as a competing event, and risk factors for death were identified using Cox models.
RESULTS.: At ART initiation, 670 children (55% female) had a median age of 6.4 years (interquartile range, 2.0-9.6), body mass index-for-age z-score -0.8 (-1.9 to 0.0), HIV ribonucleic acid viral load 5.1 log10 copies/mL (4.6-5.6), and CD4 9% (3-17). Median duration of follow-up was 7.7 years. Tuberculosis incidence was 7 per 1000 PYFU (95% confidence interval [CI], 5-11) and decreased with ART duration. Lower age-adjusted hemoglobin, hematocrit, and CD4 at ART initiation were associated with a higher risk of incident tuberculosis. Of the 30 incident tuberculosis cases, 9 died. Diagnosis of incident tuberculosis was associated with mortality (unadjusted hazard ratio = 10.2, 95% CI = 4.8-21.5, P < .001 and adjusted hazard ratio = 5.4, 95% CI = 2.5-11.7, P < .001).
CONCLUSIONS.: Incident tuberculosis was strongly associated with mortality. CD4 counts or hemoglobin or hematocrit levels may prompt clinicians to consider a possible tuberculosis infection.
我们评估了在泰国，1999 年至 2012 年间，22 个结核病高负担国家之一，开始一线抗逆转录病毒治疗（ART）的大量<15 岁人类免疫缺陷病毒（HIV）感染儿童中结核病的发病率、结核病的危险因素，以及结核病对死亡率的影响。
医生审查并分类结核病病例。发病率是指新发病例或复发病例的儿童人数，定义为在开始 ART 后>30 天首次或再次诊断为结核病，除以总随访人年（PYFU）。使用 Fine 和 Gray 的竞争风险模型确定结核病的发病危险因素，以其他原因死亡为竞争事件，并使用 Cox 模型确定死亡的危险因素。
在开始 ART 时，670 名儿童（55%为女性）的中位年龄为 6.4 岁（四分位间距，2.0-9.6），体重指数年龄 Z 评分-0.8（-1.9 至 0.0），HIV 核糖核酸病毒载量 5.1log10 拷贝/mL（4.6-5.6），CD4 9%（3-17）。中位随访时间为 7.7 年。每 1000PYFU 结核病发病率为 7 例（95%置信区间，5-11），且随 ART 时间的延长而降低。ART 开始时较低的年龄调整血红蛋白、血细胞比容和 CD4 与结核病发病风险增加相关。30 例结核病发病病例中，有 9 例死亡。结核病的诊断与死亡率相关（未调整的危险比=10.2，95%置信区间=4.8-21.5，P<0.001；调整后的危险比=5.4，95%置信区间=2.5-11.7，P<0.001）。
结核病的发生与死亡率密切相关。CD4 计数或血红蛋白或血细胞比容水平可能促使临床医生考虑可能的结核病感染。
