KEMRI/Wellcome Trust Research Programme, P.O Box 230, Kilifi, 80108, Kenya.
Department of Public Health, Pwani University, Kilifi, Kenya.
BMC Infect Dis. 2023 May 30;23(1):362. doi: 10.1186/s12879-023-08347-0.
Although tuberculosis (TB) patients coinfected with HIV are at risk of poor treatment outcomes, there is paucity of data on changing trends of TB/HIV co-infection and their treatment outcomes. This study aims to estimate the burden of TB/HIV co-infection over time, describe the treatment available to TB/HIV patients and estimate the effect of TB/HIV co-infection on TB treatment outcomes.
This was a retrospective data analyses from TB surveillance in two counties in Kenya (Nyeri and Kilifi): 2012‒2020. All TB patients aged ≥ 18 years were included. The main exposure was HIV status categorised as infected, negative or unknown status. World Health Organization TB treatment outcomes were explored; cured, treatment complete, failed treatment, defaulted/lost-to-follow-up, died and transferred out. Time at risk was from date of starting TB treatment to six months later/date of the event and Cox proportion with shared frailties models were used to estimate effects of TB/HIV co-infection on TB treatment outcomes.
The study includes 27,285 patients, median (IQR) 37 (29‒49) years old and 64% male. 23,986 (88%) were new TB cases and 91% were started on 2RHZE/4RH anti-TB regimen. Overall, 7879 (29%, 95% 28‒30%) were HIV infected. The proportion of HIV infected patient was 32% in 2012 and declined to 24% in 2020 (trend P-value = 0.01). Uptake of ARTs (95%) and cotrimoxazole prophylaxis (99%) was high. Overall, 84% patients completed six months TB treatment, 2084 (7.6%) died, 4.3% LTFU, 0.9% treatment failure and 2.8% transferred out. HIV status was associated with lower odds of completing TB treatment: infected Vs negative (aOR 0.56 (95%CI 0.52‒0.61) and unknown vs negative (aOR 0.57 (95%CI 0.44‒0.73). Both HIV infected and unknown status were associated with higher hazard of death: (aHR 2.40 (95%CI 2.18‒2.63) and 1.93 (95%CI 1.44‒2.56)) respectively and defaulting treatment/LTFU: aHR 1.16 (95%CI 1.01‒1.32) and 1.55 (95%CI 1.02‒2.35)) respectively. HIV status had no effect on hazard of transferring out and treatment failure.
The overall burden of TB/HIV coinfection was within previous pooled estimate. Our findings support the need for systematic HIV testing as those with unknown status had similar TB treatment outcomes as the HIV infected.
尽管合并感染 HIV 的结核病 (TB) 患者治疗结果不佳，但关于 TB/HIV 合并感染的变化趋势及其治疗结果的数据却很少。本研究旨在评估随时间推移的 TB/HIV 合并感染负担，描述 TB/HIV 患者的治疗情况，并评估 TB/HIV 合并感染对 TB 治疗结果的影响。
这是对肯尼亚两个县（奈罗比和基利菲）结核病监测中的回顾性数据分析：2012 年至 2020 年。所有年龄≥18 岁的结核病患者均纳入研究。主要暴露因素是 HIV 状态，分为感染、阴性或未知状态。探索了世界卫生组织的结核病治疗结果；治愈、治疗完成、治疗失败、失访/脱失、死亡和转出。风险时间从开始结核病治疗之日起至六个月后/事件发生之日止，采用共享脆弱性 Cox 比例风险模型来估计 TB/HIV 合并感染对结核病治疗结果的影响。
研究共纳入 27285 例患者，中位（IQR）年龄 37（29-49）岁，64%为男性。23986 例（88%）为新发病例，91%接受 2RHZE/4RH 抗结核方案治疗。总体而言，7879 例（29%，95% 28-30%）为 HIV 感染者。2012 年 HIV 感染者比例为 32%，2020 年下降至 24%（趋势 P 值=0.01）。抗逆转录病毒疗法（ART）的使用率（95%）和复方磺胺甲噁唑预防（99%）很高。总体而言，84%的患者完成了六个月的结核病治疗，2084 例（7.6%）死亡，4.3%失访/脱失，0.9%治疗失败，2.8%转出。HIV 状态与完成结核病治疗的可能性较低相关：感染患者比阴性患者（比值比 0.56（95%置信区间 0.52-0.61）和未知状态患者比阴性患者（比值比 0.57（95%置信区间 0.44-0.73））。HIV 感染和未知状态均与更高的死亡风险相关：（危险比 2.40（95%置信区间 2.18-2.63）和 1.93（95%置信区间 1.44-2.56）），以及治疗中断/失访：（危险比 1.16（95%置信区间 1.01-1.32）和 1.55（95%置信区间 1.02-2.35））。HIV 状态对转出和治疗失败的风险无影响。
总体上，TB/HIV 合并感染的负担处于之前的汇总估计范围内。我们的研究结果支持进行系统的 HIV 检测，因为未知状态的患者与 HIV 感染者的结核病治疗结果相似。
