Sichuan Center for Disease Control and Prevention, Chengdu, Sichuan, China.
Medicine (Baltimore). 2023 Feb 3;102(5):e32811. doi: 10.1097/MD.0000000000032811.
Mycobacterium tuberculosis is the most common opportunistic infection among patients with human immunodeficiency virus (HIV) infection, and it is also the leading cause of death, causing approximately one-third of acquired immune deficiency syndrome deaths worldwide. China is on the World Health Organization's global list of 30 high-tuberculosis (TB) burden countries. The objective of this study was to evaluate the mortality rate, survival probabilities, and factors associated with death among patients with TB/HIV co-infection undergoing TB treatment in Sichuan, China. A retrospective cohort study was conducted using the Chinese National TB Surveillance System data of TB/HIV co-infected patients enrolled in TB treatment from January 2020 to December 2020. We calculated the mortality rate and survival probabilities using the Kaplan-Meier estimator, and a Cox proportional hazard model was conducted to identify independent risk factors for TB/HIV co-infection mortality. Hazard ratios and their respective 95% confidence intervals were also reported in this study. Of 828 TB/HIV co-infected patients, 44 (5.31%) died during TB treatment, and the crude mortality rate was 7.76 per 1000 person-months. More than half of the deaths (n = 23) occurred in the first 3 months of TB treatment. Overall survival probabilities were 97.20%, 95.16%, and 91.75% at 3rd, 6th, and 12th month respectively. The independent risk factors for mortality among TB/HIV co-infected patients were having extra-pulmonary TB and pulmonary TB co-infection, history of antiretroviral therapy interruption, and baseline cluster of differentiation 4 T-lymphocyte counts <200 cells/μL at the time of HIV diagnosis. Antiretroviral therapy is important for the survival of TB/HIV co-infected patients, and it is recommended to help prolong life by restoring immune function and preventing extra-pulmonary TB.
结核分枝杆菌是人类免疫缺陷病毒（HIV）感染患者中最常见的机会性感染，也是导致死亡的主要原因，约占全球艾滋病死亡人数的三分之一。中国是世界卫生组织全球 30 个结核病（TB）高负担国家之一。本研究旨在评估中国四川接受结核病治疗的结核分枝杆菌/人类免疫缺陷病毒（TB/HIV）合并感染患者的死亡率、生存概率和与死亡相关的因素。采用中国国家结核病监测系统的数据，对 2020 年 1 月至 12 月期间接受结核病治疗的 TB/HIV 合并感染患者进行回顾性队列研究。我们使用 Kaplan-Meier 估计器计算死亡率和生存概率，并使用 Cox 比例风险模型确定 TB/HIV 合并感染死亡的独立危险因素。本研究还报告了风险比及其相应的 95%置信区间。在 828 例 TB/HIV 合并感染患者中，44 例（5.31%）在结核病治疗期间死亡，粗死亡率为每 1000 人月 7.76 例。超过一半的死亡（n=23）发生在结核病治疗的前 3 个月。第 3、6 和 12 个月的总体生存率分别为 97.20%、95.16%和 91.75%。TB/HIV 合并感染患者死亡的独立危险因素是肺部外结核和肺结核合并感染、抗逆转录病毒治疗中断史以及 HIV 诊断时的基线 CD4+T 淋巴细胞计数<200 个/μL。抗逆转录病毒治疗对 TB/HIV 合并感染患者的生存至关重要，建议通过恢复免疫功能和预防肺部外结核来帮助延长生命。
