坦桑尼亚 HIV 感染成人中异烟肼预防治疗对结核病发病率及相关危险因素的影响：一项回顾性队列研究。
Effect of isoniazid preventive therapy on tuberculosis incidence and associated risk factors among HIV infected adults in Tanzania: a retrospective cohort study.
机构信息
Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, P.O.Box 2240, Moshi, Tanzania.
School of Statistics and Actuarial Sciences, University of Kwazul-Natal, Durban, South Africa.
出版信息
BMC Infect Dis. 2019 Jan 17;19(1):62. doi: 10.1186/s12879-019-3696-x.
BACKGROUND
Tuberculosis (TB) continues to be the leading cause of morbidity and mortality among human immunodeficiency virus (HIV) infected individuals in Sub Saharan Africa including Tanzania. Provision of isoniazid preventive therapy (IPT) is one of the public health interventions to reduce the burden of TB among HIV infected persons. However there is limited information about the influence of IPT on TB incidence in Tanzania. This study aimed at ascertaining the effect of IPT on TB incidence and to determine risk factors for TB among HIV positive adults in Dar es Salaam region.
METHODS
A retrospective cohort study was conducted using secondary data of HIV positive adults receiving care and treatment services in Dar es Salaam region from 2011 to 2014. TB incidence rate among HIV positive adults on IPT was compared to those who were not on IPT during the follow up period. Risk factors for incident TB were estimated using multivariate Cox proportional hazards regression model.
RESULTS
A total of 68,378 HIV positive adults were studied. The median follow up time was 3.4 (IQR = 1.9-3.8) years for patients who ever received IPT and 1.3 (IQR = 0.3-1.3) years among those who never received IPT. A total of 3124 TB cases occurred during 114,926 total person-years of follow up. The overall TB incidence rate was 2.7/100 person-years (95%CI; 2.6-2.8). Patients on IPT had 48% lower TB incidence rate compared to patients who were not on IPT (IRR = 0.52, 95%CI; 0.46-0.59). Factors associated with higher risk for incident TB included; being male (aHR = 1.8, 95% CI; 1.6-2.0), WHO stage III (aHR = 2.7, 95% CI; 2.3-3.3) and IV (aHR = 2.4, 95% CI; 1.9-3.1),being underweight (aHR = 1.7, 95% CI; 1.5-1.9) while overweight (aHR = 0.7, 95% CI; 0.6-0.8), obese (aHR = 0.5, 95% CI; 0.4-0.7), having baseline CD4 cell count between 200 and 350 cells/μl (aHR = 0.7, 95% CI; 0.6-0.8) and CD4 count above 350 cells/μl (aHR = 0.5, 95% CI; 0.4-0.6) were associated with lower risk of developing TB.
CONCLUSION
Isoniazid preventive therapy (IPT) has shown to be effective in reducing TB incidence among HIV infected adults in Dar es Salaam. More efforts are needed to increase the provision and coverage of IPT.
背景
在撒哈拉以南非洲，包括坦桑尼亚在内，结核病（TB）仍然是导致人类免疫缺陷病毒（HIV）感染者发病和死亡的主要原因。提供异烟肼预防治疗（IPT）是减少 HIV 感染者结核病负担的公共卫生干预措施之一。然而，关于 IPT 对坦桑尼亚结核病发病率的影响的信息有限。本研究旨在确定 IPT 对结核病发病率的影响，并确定达累斯萨拉姆地区 HIV 阳性成年人中结核病的危险因素。
方法
本研究使用了达累斯萨拉姆地区从 2011 年至 2014 年接受护理和治疗服务的 HIV 阳性成年人的二级数据进行回顾性队列研究。比较了在随访期间接受 IPT 和未接受 IPT 的 HIV 阳性成年人的结核病发病率。使用多变量 Cox 比例风险回归模型估计结核病发病的危险因素。
结果
共研究了 68378 名 HIV 阳性成年人。接受 IPT 的患者中位随访时间为 3.4 年（IQR=1.9-3.8），从未接受 IPT 的患者中位随访时间为 1.3 年（IQR=0.3-1.3）。在 114926 人年的随访期间共发生了 3124 例结核病。总结核病发病率为 2.7/100 人年（95%CI；2.6-2.8）。与未接受 IPT 的患者相比，接受 IPT 的患者结核病发病率降低了 48%（IRR=0.52，95%CI；0.46-0.59）。与发生结核病相关的因素包括：男性（aHR=1.8，95%CI；1.6-2.0）、世界卫生组织（WHO）III 期（aHR=2.7，95%CI；2.3-3.3）和 IV 期（aHR=2.4，95%CI；1.9-3.1）、体重过轻（aHR=1.7，95%CI；1.5-1.9），超重（aHR=0.7，95%CI；0.6-0.8），肥胖（aHR=0.5，95%CI；0.4-0.7）、基线 CD4 细胞计数在 200 至 350 个/μl 之间（aHR=0.7，95%CI；0.6-0.8）和 CD4 计数高于 350 个/μl（aHR=0.5，95%CI；0.4-0.6）与结核病发病风险降低相关。
结论
异烟肼预防治疗（IPT）已被证明可有效降低达累斯萨拉姆 HIV 感染者的结核病发病率。需要进一步努力增加 IPT 的提供和覆盖范围。
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