Gatechompol Sivaporn, Kawkitinarong Kamon, Suwanpimolkul Gompol, Kateruttanakul Pairaj, Manosuthi Weerawat, Sophonphan Jiratchaya, Ubolyam Sasiwimol, Kerr Stephen J, Avihingsanon Anchalee, Ruxrungtham Kiat
Department of Medicine, Rajavithi Hospital, Bangkok, Thailand.
Bamrasnaradura Infectious Diseases Institute, Ministry of Public Health, Nonthaburi, Thailand.
J Virus Erad. 2019 Nov 4;5(4):225-230. doi: 10.1016/S2055-6640(20)30032-7.
This study aimed to compare treatment outcomes and factors associated with mortality in HIV-1-positive and HIV-1-negative individuals.
We conducted a cohort study between July 2008 and December 2016. Logistic regression was used to determine factors associated with outcomes and death after tuberculosis (TB) treatment.
A total of 996 individuals with TB, 228 (22.9%) with HIV-1 co-infection and 770 (77.1%) who were HIV-1 negative were reviewed. The overall treatment success rate was 74.3%. The HIV-1-negative individuals with TB had significantly higher treatment success rates (77.2% 64.5%, < 0.001). Using logistic regression analysis, age >50 years (adjusted odds ratio [aOR] 3.89, 95% confidence interval [CI] 2.24-6.76; < 0.001), body weight ≤45 kg (aOR 2.19, 95% CI 1.14-4.19; = 0.02) and HIV-1-positive status (aOR 3.31, 95% CI 1.84-5.91; < 0.001) were independently associated with death during TB treatment. Among HIV-1-positive individuals, not undergoing antiretroviral therapy (ART), having diabetes and a CD4 T cell count of <50 cells/mm were significantly associated with death.
Individuals who had both TB and HIV-1 in Thailand had lower TB treatment success and higher mortality rates compared with individuals with TB without HIV-1. Strategies to improve ART uptake and to reduce risk of developing active TB among individuals with advanced HIV-1 infection should be scaled up.
本研究旨在比较HIV-1阳性和HIV-1阴性个体的治疗结果及与死亡率相关的因素。
我们在2008年7月至2016年12月期间进行了一项队列研究。采用逻辑回归分析来确定结核病（TB）治疗后与治疗结果和死亡相关的因素。
共纳入996例结核病患者，其中228例（22.9%）合并HIV-1感染，770例（77.1%）HIV-1阴性。总体治疗成功率为74.3%。HIV-1阴性的结核病患者治疗成功率显著更高（77.2%对64.5%，P<0.001）。通过逻辑回归分析，年龄>50岁（调整优势比[aOR]3.89，95%置信区间[CI]2.24 - 6.76；P<0.001）、体重≤45 kg（aOR 2.19，95% CI 1.14 - 4.19；P = 0.02）和HIV-1阳性状态（aOR 3.31，95% CI 1.84 - 5.91；P<0.001）与结核病治疗期间的死亡独立相关。在HIV-1阳性个体中，未接受抗逆转录病毒治疗（ART）、患有糖尿病以及CD4 T细胞计数<50个细胞/mm³与死亡显著相关。
与未感染HIV-1的结核病患者相比，泰国同时患有结核病和HIV-1的个体结核病治疗成功率较低且死亡率较高。应扩大提高ART覆盖率以及降低晚期HIV-1感染个体发生活动性结核病风险的策略。
