International Union Against Tuberculosis and Lung Disease (The Union), Mandalay, Myanmar.
The Union, Paris, France, London School of Hygiene & Tropical Medicine, London, UK.
Int J Tuberc Lung Dis. 2019 Mar 1;23(3):349-357. doi: 10.5588/ijtld.18.0436.
Two human immunodeficiency virus (HIV) clinics providing antiretroviral therapy (ART), Mandalay, Myanmar.
To assess prevalent TB at enrolment, incident TB during follow-up and associated risk factors in adult people living with HIV (PLHIV) between 2011 and 2017.
Cohort study using secondary data.
Of 11 777 PLHIV, 2911 (25%) had prevalent TB at or within 6 weeks of enrolment. Independent risk factors for prevalent TB were being male or single/widowed, daily alcohol consumption, CD4 count 200 cells/μl and anaemia. During 6 years follow-up in 8866 PLHIV with no prevalent TB, the rate of new TB was 2.9 per 100 person-years (95%CI 2.6-3.1). Cumulative TB incidence was 9.6%, with 370 (72%) of 517 new TB cases occurring in the first year. Independent risk factors for incident TB were being male and anaemia. Incident TB was highest in the first year of ART, in PLHIV with CD4 counts 200 cells/μl and those not receiving isoniazid preventive therapy (IPT). Incident TB declined with time on ART and rising CD4 counts.
Prevalent and incident TB were high in PLHIV in the Mandalay clinics. Consideration should be given to earlier TB diagnosis using more sensitive diagnostic tools, effective ART and scaling up IPT.
两家提供抗逆转录病毒疗法（ART）的人类免疫缺陷病毒（HIV）诊所，缅甸曼德勒。
评估 2011 年至 2017 年期间成年 HIV 感染者（PLHIV）入组时的现患结核病、随访期间新发结核病及相关危险因素。
使用二级数据的队列研究。
在 11777 名 PLHIV 中，2911 名（25%）在入组时或入组后 6 周内患有现患结核病。现患结核病的独立危险因素为男性或单身/丧偶、每日饮酒、CD4 计数≤200 个细胞/μl 和贫血。在 8866 名无现患结核病的 PLHIV 中，6 年随访期间新结核病的发生率为 2.9/100 人年（95%CI 2.6-3.1）。累积结核病发病率为 9.6%，517 例新发结核病中有 370 例（72%）发生在第 1 年。新发结核病的独立危险因素为男性和贫血。在接受 ART 的第一年、CD4 计数≤200 个细胞/μl 的 PLHIV 和未接受异烟肼预防性治疗（IPT）的 PLHIV 中，新发结核病发病率最高。随着 ART 时间的延长和 CD4 计数的升高，新发结核病的发病率下降。
曼德勒诊所的 PLHIV 现患和新发结核病率均较高。应考虑使用更敏感的诊断工具、有效的 ART 和扩大 IPT 来更早地诊断结核病。
