Zheng Z G, Geng W K, Lu Z Z, Li J J, Zhou C X, Yang W M
Department of AIDS Control and Prevention, Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning 530028, China.
Special Office of AIDS Prevention and Treatment, Guangxi Zhuang Autonomous Region Commission of Health and Family Planning, Nanning 530021, China.
Zhonghua Liu Xing Bing Xue Za Zhi. 2018 Oct 10;39(10):1362-1367. doi: 10.3760/cma.j.issn.0254-6450.2018.10.014.
To understand the impact of HIV and (MTB) co-infectious (HIV/MTB) on related mortality in Guangxi Zhuang Autonomous Region, provide evidence for the development of a better HIV/MTB co-infection control and prevention program. A multiple cross-systems check (MCSC) approach was used to confirm the HIV/MTB co-infection individuals on data related to treatment, follow-up, epidemiological comprehensive and (TB) special report system. Social demography characteristics, incidence of TB among HIV positive individuals, HIV incidence among MTB infection persons , were described. We compared the mortalities and related risks between HIV/MTB co-infection and mono HIV positive individuals as well as between the HIV/MTB co-infection and mono MTB infection persons, using both the Chi Square test and the Cox's proportional hazard regression model (Cox). Reported data showed that the incidence of MTB co-infection in the HIV cohort was 17.72% (2 533/14 293), while HIV incidence in the TB patients was 5.57% (2 351/42 205), respectively. The mortality of HIV/MTB co-infection in the HIV/AIDS cohort was 15.16% (384/2 533) within one-year of observation and was significantly higher than the mortality (13.63%,1 603/11 760) of mono HIV positive individuals (<0.000 1). The percentage of the HIV/AIDS death cases was 19.33% (384/1 987) who registered and died in the 2011 calendar year were caused by MTB co-infection. Among all the HIV/MTB co-infection patients who had been identified from the HIV cohort, 60.05% (1 521/2 533) had initiated ART, 15.48% (392/2 533) had been cured for TB and 27.48% (696/2 533) had been under complete TB regimen. Among the confirmed HIV/MTB cases from the TB cohort, the cure rate of TB was 19.70% (463/2 351) and the percentage of completed TB regimen was 37.26% (876/2 351). The percentage of the individuals whose CD(4)(+) T lymphocyte cells count appeared less than 200 cell/μl was 64.13% (785/1 224), upon the HIV diagnoses were made. Compared with individuals who were under mono HIV infection, the mortality risk on HIV/MTB co-infection was 1.17 times higher during the five-year observation period, then the patients with only mono MTB infection and the mortality risk in patients with HIV/MTB co-infection was 25.68 times higher under the 12-month observation period. Both the incidence and mortality of HIV/MTB appeared high in Guangxi, with mortality and the risk of mortality in the HIV/MTB co-infection group significantly higher than that in both the HIV mono infection and the MTB mono infections groups. Both the rate of antiretroviral treatment coverage and the cure rate of TB treatment should be increased in no time as well as the capability of early TB case-finding among people living with HIV.
为了解广西壮族自治区人类免疫缺陷病毒（HIV）与结核分枝杆菌（MTB）合并感染（HIV/MTB）对相关死亡率的影响，为制定更好的HIV/MTB合并感染防控方案提供依据。采用多系统交叉核对（MCSC）方法，通过治疗、随访、流行病学综合及结核病（TB）专项报告系统的数据，确认HIV/MTB合并感染个体。描述了社会人口学特征、HIV阳性个体中的结核病发病率、MTB感染人群中的HIV发病率。我们使用卡方检验和Cox比例风险回归模型（Cox），比较了HIV/MTB合并感染与单纯HIV阳性个体之间以及HIV/MTB合并感染与单纯MTB感染个体之间的死亡率及相关风险。报告数据显示，HIV队列中MTB合并感染的发生率为17.72%（2533/14293），而结核病患者中HIV的发病率为5.57%（2351/42205）。HIV/AIDS队列中HIV/MTB合并感染在观察期1年内的死亡率为15.16%（384/2533），显著高于单纯HIV阳性个体的死亡率（13.63%，1603/11760）（<0.0001）。2011日历年登记死亡的HIV/AIDS死亡病例中，19.33%（384/1987）是由MTB合并感染所致。在从HIV队列中识别出的所有HIV/MTB合并感染患者中，60.05%（1521/2533）开始接受抗逆转录病毒治疗（ART），15.48%（392/2533）的结核病已治愈，27.48%（696/2533）正在接受完整的结核病治疗方案。在从结核病队列中确诊的HIV/MTB病例中，结核病治愈率为19.70%（463/2351），完成结核病治疗方案的比例为37.26%（876/2351）。在做出HIV诊断时，CD4+T淋巴细胞计数低于200个细胞/μl的个体比例为64.13%（785/1224）。与单纯HIV感染个体相比，在五年观察期内HIV/MTB合并感染的死亡风险高1.17倍，而与单纯MTB感染患者相比，在12个月观察期内HIV/MTB合并感染患者的死亡风险高25.68倍。广西HIV/MTB的发病率和死亡率均较高，HIV/MTB合并感染组的死亡率和死亡风险显著高于HIV单纯感染组和MTB单纯感染组。应立即提高抗逆转录病毒治疗覆盖率和结核病治疗治愈率，以及提高HIV感染者中结核病早期发现的能力。
