U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD.
Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, MD.
J Acquir Immune Defic Syndr. 2023 Apr 15;92(5):359-369. doi: 10.1097/QAI.0000000000003152. Epub 2023 Jan 3.
The prevalence and incidence of tuberculosis (TB) is high among people living with HIV (PLWH) but is often underdiagnosed in HIV programmatic settings.
President's Emergency Plan for AIDS Relief (PEPFAR)-supported research sites in Uganda, Kenya, Tanzania, and Nigeria.
All patients underwent molecular testing at entry into a longitudinal cohort of PLWH and annually thereafter. We assessed the prevalence and incidence of TB and identified clinical and demographic factors associated with prevalent and incident TB using logistic regression and Cox proportional hazard models.
From 21 January, 2013, to 1 December 2021, 3171 PLWH were enrolled with a TB prevalence of 3% (n = 93). Of the cases with prevalent TB, 66% (n = 61) were bacteriologically confirmed. The adjusted odds of prevalent TB were significantly higher among those with higher educational attainment, PLWH for 1-5 years since their HIV diagnosis, those who were underweight, and those with CD4 counts <200 cells/mm 3 . The overall TB incidence rate was 600 per 100,000 person-years (95% CI: 481-748). We found that shorter time since HIV diagnosis, being underweight, taking antiretroviral therapy <6 months, and having a CD4 count <200 cells/mm 3 were significantly associated with incident TB. PLWH on dolutegravir/lamivudine/tenofovir had a 78% lower risk of incident TB compared with those on tenofovir/lamivudine/efavirenz (hazard ratio: 0.22; 95% CI: 0.08-0.63).
The prevalence and incidence of TB was notably high in this cohort sourced from PEPFAR clinics. Aggressive efforts to enhance HIV diagnosis and optimize treatment in programmatic settings are warranted to reduce the risk of HIV-TB co-occurrence in this cohort.
在艾滋病毒感染者（PLWH）中，结核病（TB）的患病率和发病率很高，但在艾滋病毒规划环境中往往诊断不足。
乌干达、肯尼亚、坦桑尼亚和尼日利亚的总统艾滋病紧急救援计划（PEPFAR）支持的研究点。
所有患者在进入 PLWH 纵向队列时接受分子检测，此后每年进行一次。我们评估了 TB 的患病率和发病率，并使用逻辑回归和 Cox 比例风险模型确定了与现患和新发 TB 相关的临床和人口统计学因素。
从 2013 年 1 月 21 日至 2021 年 12 月 1 日，共纳入了 3171 名 PLWH，TB 患病率为 3%（93 例）。在现患 TB 病例中，有 66%（61 例）经细菌学证实。在调整了教育程度较高、HIV 诊断后 1-5 年的 PLWH、体重不足和 CD4 计数<200 个细胞/mm3等因素后，现患 TB 的调整后比值比显著更高。总的 TB 发病率为每 100000 人年 600 例（95%CI：481-748）。我们发现，HIV 诊断后时间较短、体重不足、接受抗逆转录病毒治疗<6 个月以及 CD4 计数<200 个细胞/mm3 与新发 TB 显著相关。与接受替诺福韦/拉米夫定/依法韦仑治疗的 PLWH 相比，接受多替拉韦/拉米夫定/替诺福韦治疗的 PLWH 新发 TB 的风险降低了 78%（危险比：0.22；95%CI：0.08-0.63）。
从 PEPFAR 诊所获得的这一队列中，TB 的患病率和发病率均显著较高。需要在规划环境中大力努力加强 HIV 诊断和优化治疗，以降低该队列中 HIV-TB 共病的风险。
