Clinic of Infectious Diseases and Dermatovenerology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
Centre of Infectious Diseases, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania.
PLoS One. 2023 Mar 23;18(3):e0282046. doi: 10.1371/journal.pone.0282046. eCollection 2023.
Tuberculosis (TB) is a public health problem in Lithuania, among the 18 high-priority TB countries in the European region, and the most common AIDS-indicative disease with the highest proportion in the EU/EEA since 2015. The study aimed to identify socio-demographic, clinical characteristics and their relationship with TB outcomes in TB-HIV co-infected patients in Lithuania.
A retrospective chart review analysed the characteristics of TB-HIV co-infected adults registered in State Information System of Tuberculosis over 2008-2020. The factors associated with drug-resistant TB and unsuccessful treatment outcome were identified by multivariable logistic regression.
The study included 345 cases in 311 patients (239 new, 106 previously treated cases), median age 40 years (IQR 35-45), 80.7% male. 67.8% patients knew their HIV-positive status before TB diagnosis, median time to TB diagnosis was 8 years (IQR 4-12). 83.6% were unemployed, 50.5%-anytime intravenous drug users (IDU), 34.9% abused alcohol. Drug-resistant TB rates in new and previously treated TB cases were 38.1% and 61.3%, respectively. In multivariable analysis, higher risk of drug-resistant TB was associated with imprisonment in new (aOR 3.35; 95%CI 1.17-9.57) and previously treated (aOR 6.63; 95%CI 1.09-40.35) cases. In 52.3% of new TB cases and in 42.5% previously treated TB cases the treatment outcomes were unsuccessful. In multivariable analysis of new TB cases, current imprisonment (aOR 2.77; 95%CI 1.29-5.91) and drug-resistant TB (aOR 2.18; 95%CI 1.11-4.28) were associated with unsuccessful treatment outcome. In multivariable analysis of previously treated TB cases, female gender (aOR 11.93; 95%CI 1.86-76.69), alcohol abuse (aOR 3.17; 95%CI 1.05-9.58), drug-resistant TB (aOR 4.83; 95%CI 1.53-15.28) were associated with unsuccessful treatment outcome.
In the TB-HIV-infected adult cohort in Lithuania, unemployment, imprisonment, IDU, alcohol abuse, known to be risk factors for TB, were very frequent. Drug resistance was an undeniable risk factor for unsuccessful treatment outcome and imprisonment was associated with drug resistant TB.
结核病（TB）是立陶宛的一个公共卫生问题，在欧洲区域 18 个结核病高度优先国家中排名较高，并且自 2015 年以来是欧盟/欧洲经济区中艾滋病指示疾病中比例最高的疾病。本研究旨在确定立陶宛结核分枝杆菌-人类免疫缺陷病毒（TB-HIV）合并感染患者的社会人口学、临床特征及其与结核病结局的关系。
回顾性分析了国家结核病信息系统中登记的 2008 年至 2020 年期间的 TB-HIV 合并感染成人的特征。采用多变量逻辑回归分析确定与耐药结核病和治疗失败结局相关的因素。
该研究共纳入了 311 名患者中的 345 例（239 例新发，106 例既往治疗），中位年龄 40 岁（IQR 35-45），80.7%为男性。67.8%的患者在诊断结核病之前就知道自己 HIV 阳性，结核病诊断的中位时间为 8 年（IQR 4-12）。83.6%的患者失业，50.5%-随时静脉吸毒者（IDU），34.9%滥用酒精。新发和既往治疗结核病病例的耐药结核病发生率分别为 38.1%和 61.3%。多变量分析显示，新发病例（aOR 3.35；95%CI 1.17-9.57）和既往治疗病例（aOR 6.63；95%CI 1.09-40.35）中入狱与耐药结核病的风险更高。在 52.3%的新发结核病病例和 42.5%的既往治疗结核病病例中，治疗结局不成功。多变量分析新发结核病病例时，目前监禁（aOR 2.77；95%CI 1.29-5.91）和耐药结核病（aOR 2.18；95%CI 1.11-4.28）与治疗结局不成功相关。多变量分析既往治疗结核病病例时，女性（aOR 11.93；95%CI 1.86-76.69）、酒精滥用（aOR 3.17；95%CI 1.05-9.58）、耐药结核病（aOR 4.83；95%CI 1.53-15.28）与治疗结局不成功相关。
在立陶宛的结核分枝杆菌-人类免疫缺陷病毒感染的成年队列中，失业、监禁、IDU、酒精滥用是结核病的已知危险因素，非常普遍。耐药是治疗失败结局的一个不可否认的危险因素，而监禁与耐药结核病有关。
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