中国广西HIV/AIDS患者中与结核病（TB）相关的危险因素：一项配对病例对照研究
Risk factors associated with Tuberculosis (TB) among people living with HIV/AIDS: A pair-matched case-control study in Guangxi, China.
作者信息
Cui Zhezhe, Lin Mei, Nie Shaofa, Lan Rushu
机构信息
Guangxi Zhuang Autonomous region center for disease prevention and control, Guangxi, China.
Department of Epidemiology and Statistics, Public Health School, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
出版信息
PLoS One. 2017 Mar 30;12(3):e0173976. doi: 10.1371/journal.pone.0173976. eCollection 2017.
BACKGROUND
As one of the poorest provinces in China, Guangxi has a high HIV and TB prevalence, with the annual number of TB/HIV cases reported by health department among the highest in the country. However, studies on the burden of TB-HIV co-infection and risk factors for active TB among HIV-infected persons in Guangxi have rarely been reported.
OBJECTIVE
To investigate the risk factors for active TB among people living with HIV/AIDS in Guangxi Zhuang autonomous region, China.
METHODS
A surveillance survey was conducted of 1 019 HIV-infected patients receiving care at three AIDS prevention and control departments between 2013 and 2015. We investigated the cumulative prevalence of TB during 2 years. To analyze risk factors associated with active TB, we conducted a 1:1 pair-matched case-control study of newly reported active TB/HIV co-infected patients. Controls were patients with HIV without active TB, latent TB infection or other lung disease, who were matched with the case group based on sex and age (± 3 years).
RESULTS
A total of 1 019 subjects were evaluated. 160 subjects (15.70%) were diagnosed with active TB, including 85 clinically diagnosed cases and 75 confirmed cases. We performed a 1:1 matched case-control study, with 82 TB/HIV patients and 82 people living with HIV/AIDS based on surveillance site, sex and age (±3) years. According to multivariate analysis, smoking (OR = 2.996, 0.992-9.053), lower CD 4+ T-cell count (OR = 3.288, 1.161-9.311), long duration of HIV-infection (OR = 5.946, 2.221-15.915) and non-use of ART (OR = 7.775, 2.618-23.094) were independent risk factors for TB in people living with HIV/AIDS.
CONCLUSION
The prevalence of active TB among people living with HIV/AIDS in Guangxi was 173 times higher than general population in Guangxi. It is necessary for government to integrate control planning and resources for the two diseases. Medical and public health workers should strengthen health education for TB/HIV prevention and treatment and promote smoking cessation. Active TB case finding and early initiation of ART is necessary to minimize the burden of disease among patients with HIV, as is IPT and infection control in healthcare facilities.
背景
作为中国最贫困的省份之一，广西的艾滋病毒和结核病患病率很高，卫生部门报告的结核病/艾滋病毒病例数每年居全国前列。然而，关于广西艾滋病毒感染者中结核病-艾滋病毒合并感染负担及活动性结核病危险因素的研究鲜有报道。
目的
调查中国广西壮族自治区艾滋病毒/艾滋病感染者中活动性结核病的危险因素。
方法
对2013年至2015年期间在三个艾滋病防治部门接受治疗的1019名艾滋病毒感染者进行了一项监测调查。我们调查了两年内结核病的累积患病率。为分析与活动性结核病相关的危险因素，我们对新报告的活动性结核病/艾滋病毒合并感染患者进行了1:1配对病例对照研究。对照为没有活动性结核病、潜伏性结核感染或其他肺部疾病的艾滋病毒感染者，根据性别和年龄（±3岁）与病例组进行匹配。
结果
共评估了1019名受试者。160名受试者（15.70%）被诊断为活动性结核病，其中85例为临床诊断病例，75例为确诊病例。我们进行了1:1匹配病例对照研究，根据监测地点、性别和年龄（±3岁），选取了82例结核病/艾滋病毒患者和82例艾滋病毒/艾滋病感染者。多因素分析显示，吸烟（OR = 2.996，0.992 - 9.053）、较低的CD4 + T细胞计数（OR = 3.288，1.161 - 9.311）、较长的艾滋病毒感染时间（OR = 5.946，2.221 - 15.915）和未使用抗逆转录病毒治疗（OR = 7.775，2.618 - 23.094）是艾滋病毒/艾滋病感染者患结核病的独立危险因素。
结论
广西艾滋病毒/艾滋病感染者中活动性结核病的患病率比广西普通人群高173倍。政府有必要整合这两种疾病的防控规划和资源。医疗卫生工作者应加强结核病/艾滋病毒防治的健康教育并促进戒烟。积极开展结核病病例发现并尽早启动抗逆转录病毒治疗对于减轻艾滋病毒感染者的疾病负担很有必要，在医疗机构中开展预防性抗结核治疗和感染控制也是如此。
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