Division of Tuberculosis Elimination, US Centers for Disease Control and Prevention (CDC), National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Mailstop US12-4, 1600 Clifton Road, Atlanta, GA, 30329, USA.
J Racial Ethn Health Disparities. 2020 Oct;7(5):865-873. doi: 10.1007/s40615-020-00709-7. Epub 2020 Feb 14.
Persons living with HIV are more likely to have tuberculosis (TB) disease attributed to recent transmission (RT) and to die during TB treatment than persons without HIV. We examined factors associated with RT or mortality among TB/HIV patients.
Using National TB Surveillance System data from 2011 to 2016, we calculated multivariable adjusted odds ratios (aOR) with 99% confidence intervals (CI) to estimate associations between patient characteristics and RT or mortality. Mortality analyses were restricted to 2011-2014 to allow sufficient time for reporting outcomes.
TB disease was attributed to RT in 491 (20%) of 2415 TB/HIV patients. RT was more likely among those reporting homelessness (aOR, 2.6; CI, 2.0, 3.5) or substance use (aOR,1.6; CI, 1.2, 2.1) and among blacks (aOR,1.8; CI, 1.2, 2.8) and Hispanics (aOR, 1.8; CI, 1.1, 2.9); RT was less likely among non-US-born persons (aOR, 0.2; CI, 0.2, 0.3). The proportion who died during TB treatment was higher among persons with HIV than without (8.6% versus 5.2%; p < 0.0001). Among 2273 TB/HIV patients, 195 died during TB treatment. Age ≥ 65 years (aOR, 5.3; CI, 2.4, 11.6), 45-64 years (aOR, 2.2; CI, 1.4, 3.4), and having another medical risk factor for TB (aOR, 3.3; CI, 1.8, 6.2) were associated with death; directly observed treatment (DOT) for TB was protective (aOR, 0.5; CI, 0.2, 1.0).
Among TB/HIV patients, blacks, Hispanics, and those reporting homelessness or substance use should be prioritized for interventions that decrease TB transmission. Improved adherence to treatment through DOT was associated with decreased mortality, but additional interventions are needed to reduce mortality among older patients and those TB/HIV patients with another medical risk factor for TB.
与未感染 HIV 的人相比，HIV 感染者更有可能因近期传播（RT）而患上结核病（TB），并且在结核病治疗期间死亡。我们研究了与 TB/HIV 患者 RT 或死亡率相关的因素。
利用 2011 年至 2016 年国家结核病监测系统的数据，我们计算了多变量调整后的优势比（aOR）及其 99%置信区间（CI），以评估患者特征与 RT 或死亡率之间的关系。由于需要足够的时间报告结果，因此将死亡率分析限于 2011-2014 年。
在 2415 例 TB/HIV 患者中，有 491 例（20%）的结核病归因于 RT。报告无家可归（aOR，2.6；CI，2.0，3.5）或药物滥用（aOR，1.6；CI，1.2，2.1）的患者以及黑人和西班牙裔（aOR，1.8；CI，1.2，2.8）更有可能发生 RT；而非美国出生的人发生 RT 的可能性较低（aOR，0.2；CI，0.2，0.3）。与没有 HIV 的人相比，HIV 感染者在结核病治疗期间死亡的比例更高（8.6%比 5.2%；p<0.0001）。在 2273 例 TB/HIV 患者中，有 195 人在结核病治疗期间死亡。年龄≥65 岁（aOR，5.3；CI，2.4，11.6），45-64 岁（aOR，2.2；CI，1.4，3.4），以及有其他结核病医疗风险因素（aOR，3.3；CI，1.8，6.2）与死亡相关；直接观察治疗（DOT）可降低结核病死亡率（aOR，0.5；CI，0.2，1.0）。
在 TB/HIV 患者中，黑人、西班牙裔以及报告无家可归或药物滥用的患者应优先考虑采取减少结核病传播的干预措施。通过 DOT 提高治疗依从性与降低死亡率相关，但需要采取其他干预措施来降低老年患者和有其他结核病医疗风险因素的 TB/HIV 患者的死亡率。
