Centre for the AIDS Programme of Research in South Africa, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
South African Medical Research Council-CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa.
Clin Infect Dis. 2022 Oct 29;75(9):1628-1636. doi: 10.1093/cid/ciac185.
Undiagnosed asymptomatic subclinical tuberculosis (TB) remains a significant threat to global TB control, accounting for a substantial proportion of cases among people living with human immunodeficiency virus (HIV)/AIDS (PLWHA). We determined incidence, progression, and outcomes of subclinical TB in antiretroviral therapy (ART)-accessing PLWHA with known previous TB in South Africa.
A total of 402 adult PLWHA previously treated for TB were enrolled in the prospective Centre for the AIDS Programme of Research in South Africa TRuTH (TB Recurrence Upon TB and HIV treatment) Study. Participants were screened for TB with quarterly clinical and bacteriologic evaluation and biannual chest radiographs over 36 months. Those with suspected or confirmed TB were referred to the National TB Programme. Participants received HIV services, including ART. Incidence rate of TB was estimated using Poisson regression and descriptive statistical analyses summarized data.
A total of 48 of 402 (11.9%) bacteriologically confirmed incident recurrent TB cases were identified, comprising 17 of 48 (35.4%) subclinical TB cases and 31 of 48 (64.5%) clinical TB cases. Age, sex, and body mass index were similar among subclinical, clinical, and no TB groups. Incidence rates (95% Confidence Interval [CI]) of recurrent TB overall, in clinical and subclinical TB groups were 2.3 (1.7-3.0), 1.5 (1.1-2.2), and 0.9 (0.5-1.4) per 100 person-years, respectively. In the subclinical TB group, 14 of 17 (82.4%) were diagnosed by TB culture only, 11 of 17 (64.7%) received TB treatment, and 6 of 17 (35.3%) resolved TB spontaneously.
High incidence rates of recurrent subclinical TB in PLWHA highlight inadequacies of symptom-based TB screening in high TB-HIV burden settings.
未确诊的无症状亚临床结核病（TB）仍然是全球结核病控制的重大威胁，在艾滋病毒/艾滋病（PLWHA）人群中占相当大比例。我们确定了南非接受抗逆转录病毒治疗（ART）的已知既往结核病 PLWHA 中亚临床 TB 的发生率、进展和结局。
共有 402 名先前接受过结核病治疗的成年 PLWHA 参加了南非艾滋病方案研究中心（TRuTH）前瞻性研究（TB 在 TB 和 HIV 治疗后复发）。参与者每季度进行临床和细菌学评估，并在 36 个月内每两年进行一次胸部 X 光检查，以筛查结核病。对疑似或确诊结核病的患者转介到国家结核病规划。参与者接受了 HIV 服务，包括 ART。使用泊松回归和描述性统计分析来估计结核病的发病率，并总结数据。
共发现 48 例经细菌学证实的复发性结核病病例（11.9%），其中 17 例（35.4%）为亚临床结核病病例，31 例（64.5%）为临床结核病病例。亚临床、临床和无结核病组的年龄、性别和体重指数相似。总复发结核病、临床和亚临床结核病组的发病率（95%置信区间[CI]）分别为 2.3（1.7-3.0）、1.5（1.1-2.2）和 0.9（0.5-1.4）/100 人年。在亚临床结核病组中，17 例中的 14 例（82.4%）仅通过结核培养诊断，11 例（64.7%）接受了结核病治疗，6 例（35.3%）结核病自发消退。
PLWHA 中复发性亚临床结核病的高发病率突出了在高结核病-艾滋病毒负担环境中基于症状的结核病筛查的不足。
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