中国江苏省 HIV 感染者潜伏性结核感染的阳性率及危险因素。

Positive rate and risk factors of latent tuberculosis infection among persons living with HIV in Jiangsu Province, China.

机构信息

Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu, China.

School of Public Health, Southeast University, Nanjing, Jiangsu, China.

出版信息

Front Cell Infect Microbiol. 2023 Mar 7;13:1051060. doi: 10.3389/fcimb.2023.1051060. eCollection 2023.

DOI:10.3389/fcimb.2023.1051060

PMID:36960041

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10029977/

Abstract

OBJECTIVE

To analyze the latent tuberculosis infection (LTBI) among persons living with HIV(PLWH) in Jiangsu Province, to explore the factors affecting the positive rate of LTBI, and to take appropriate measures to control tuberculosis (TB) infection.

METHODS

A cross-sectional study was conducted among PLWH in Jiangsu Province from June to July 2021. All PLWH in Jiangsu Province were used as the study population. Currently, the diagnosis of LTBI lacks a "gold standard" and can only be assisted by the immunological method. In this study, Tuberculin skin test (TST), ESAT6-CFP10 test (EC), and QuantiFERON-TB gold in-tube (QFT) were used to detect the positive rate of LTBI among PLWH and to analyze their risk factors.

RESULTS

A total of 340 prisoners were included, 89.7% were male, the median age was 38 years [Interquartile Range (IQR):32-46 years], these patients were on Antiviral Therapy (ART), and median CD4 counts was 376 (IQR: 261-496), 103 (30.3%) were positive in at least one test, LTBI by TST was 16.5%, LTBI by EC was 15.9%, LTBI by QFT was 26.2%. Univariate analysis showed the results for TST, EC, and QFT were not affected by CD4 counts (p>0.05), and multivariate analysis showed that a history of incarceration was associated with an increased risk of positive TST (adjusted odds ratio [aOR]=1.98;95% CI,1.03-3.82), EC (aOR=2.65;95% CI,1.37-5.12) and QFT (aOR=2.01;95%CI,1.12-3.57), in addition, female gender was associated with increased risk of positive TST (aOR=3.66;95%CI,1.60-8.37) and EC (aOR=3.43;95%CI,1.46-8.07), and contact history of TB patients was associated with increased risk of TST (aOR= 2.54;95%CI,1.23-5.22) and QFT (aOR=2.03;95%CI,1.03-3.99), and ethnic minorities (aOR=0.26;95%CI,0.12-0.57), longer duration of incarceration was associated with an increased risk of positive QFT (aOR=1.12;95%CI,1.02-1.24). Conclusions Female gender, and ethnic minorities, history of incarceration, longer duration of incarceration, and contact history of TB patients are risk factors for LTBI among PLWH in Jiangsu Province, and attention should be paid to TB control in this population.

摘要

目的

分析江苏省 HIV 感染者（PLWH）中潜伏性结核感染（LTBI）的情况，探讨影响 LTBI 阳性率的因素，采取适当措施控制结核病（TB）感染。

方法

采用横断面研究方法，对 2021 年 6 月至 7 月江苏省的 PLWH 进行调查。以江苏省所有 PLWH 作为研究对象。目前，LTBI 的诊断缺乏“金标准”，只能辅助免疫方法。本研究采用结核菌素皮肤试验（TST）、ESAT6-CFP10 试验（EC）和 QuantiFERON-TB gold in-tube（QFT）检测 PLWH 的 LTBI 阳性率，并分析其危险因素。

结果

共纳入 340 名囚犯，其中 89.7%为男性，中位年龄为 38 岁[四分位距（IQR）：32-46 岁]，这些患者正在接受抗病毒治疗（ART），中位 CD4 计数为 376（IQR：261-496），103 例（30.3%）至少有一项检测结果阳性，TST 阳性率为 16.5%，EC 阳性率为 15.9%，QFT 阳性率为 26.2%。单因素分析显示，TST、EC 和 QFT 结果不受 CD4 计数的影响（p＞0.05），多因素分析显示，监禁史与 TST（调整优势比[aOR]=1.98；95%CI，1.03-3.82）、EC（aOR=2.65；95%CI，1.37-5.12）和 QFT（aOR=2.01；95%CI，1.12-3.57）阳性率增加有关，此外，女性与 TST（aOR=3.66；95%CI，1.60-8.37）和 EC（aOR=3.43；95%CI，1.46-8.07）阳性率增加有关，与 TB 患者的接触史与 TST（aOR=2.54；95%CI，1.23-5.22）和 QFT（aOR=2.03；95%CI，1.03-3.99）阳性率增加有关，少数民族（aOR=0.26；95%CI，0.12-0.57）与 QFT 阳性率增加有关，监禁时间较长与 QFT 阳性率增加有关（aOR=1.12；95%CI，1.02-1.24）。结论：女性、少数民族、监禁史、较长的监禁时间和 TB 患者接触史是江苏省 PLWH 中 LTBI 的危险因素，应关注该人群的 TB 控制。