立陶宛艾滋病毒感染者和未感染艾滋病毒个体中的潜伏性结核感染及相关危险因素

Latent Tuberculosis Infection and Associated Risk Factors among People Living with HIV and HIV-Uninfected Individuals in Lithuania.

作者信息

Matulyte Elzbieta, Kancauskiene Zavinta, Kausas Aidas, Urboniene Jurgita, Lipnickiene Vilnele, Kopeykiniene Jelena, Gudaitis Tomas, Raudonis Sarunas, Danila Edvardas, Costagliola Dominique, Matulionyte Raimonda

机构信息

Department of Infectious Diseases and Dermatovenerology, Faculty of Medicine, Vilnius University Hospital Santaros Klinikos, Vilnius University, LT-08410 Vilnius, Lithuania.

Department of Infectious Diseases, University Hospital of Klaipeda, LT-92888 Klaipeda, Lithuania.

出版信息

Pathogens. 2023 Jul 28;12(8):990. doi: 10.3390/pathogens12080990.

DOI:10.3390/pathogens12080990

PMID:37623950

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10459141/

Abstract

BACKGROUND

People living with HIV (PLHIV) with latent tuberculosis infection (LTBI) are at increased risk of tuberculosis (TB) reactivation compared to the HIV-negative population. Lithuania belongs to the 18 high-priority TB countries in the European region. The aim of this study was to compare the prevalence of LTBI and LTBI-related risk factors between PLHIV and HIV-uninfected populations.

METHODS

A cross-sectional study was conducted in three Lithuanian Infectious Diseases centres from August 2018 to May 2022 using the interferon gamma release assay (IGRA) and tuberculin skin test (TST) in Vilnius, and IGRA only in Siauliai and Klaipeda. Cohen's kappa was used to assess IGRA and TST agreement. A structured questionnaire was completed by the study participants. LTBI-related risk factors were identified using a multivariable logistic regression model.

RESULTS

In total, 391 PLHIV and 443 HIV-uninfected individuals enrolled, with a median age of 41 (IQR 36-48) and 43 (IQR 36-50), consisting of 69.8% and 65.5% male, respectively. The prevalence of LTBI defined by positive IGRA and/or TST among PLHIV was higher compared to that in the HIV-uninfected population (20.5% vs. 15.3%; OR 1.42; 95% CI 1.02-2.03; = 0.04). The concordance between IGRA and TST was fair: kappa = 0.23 (95% CI 0.09-0.34). In multivariable analyses, association with injecting drug use (IDU) (ORa 2.25, 95% CI 1.27-3.99, = 0.01) and imprisonment (ORa 1.99, 95% CI 1.13-3.52, = 0.02) in all participants, IDU (ORa 2.37, 95% CI 1.09-5.15; = 0.029) in PLHIV and a history of contact with an active TB patient (ORa 3.33, 95% CI 1.53-7.24; = 0.002) in HIV-uninfected individuals were significant associations evidenced by LTBI.

CONCLUSIONS

The prevalence of LTBI among PLHIV in Lithuania is higher compared to that in the HIV-uninfected population and the European average. The association with IDU in PLHIV emphasizes the need for integrated HIV, TB and substance abuse treatment to provide patient-centred care.

摘要

背景

与未感染艾滋病毒的人群相比，感染艾滋病毒（PLHIV）且患有潜伏性结核感染（LTBI）的人结核病（TB）复发风险更高。立陶宛属于欧洲区域18个结核病高优先国家。本研究的目的是比较PLHIV与未感染艾滋病毒人群中LTBI的患病率及与LTBI相关的危险因素。

方法

2018年8月至2022年5月在立陶宛的三个传染病中心进行了一项横断面研究，在维尔纽斯使用干扰素γ释放试验（IGRA）和结核菌素皮肤试验（TST），在希奥利艾和克莱佩达仅使用IGRA。采用科恩kappa系数评估IGRA和TST的一致性。研究参与者完成了一份结构化问卷。使用多变量逻辑回归模型确定与LTBI相关的危险因素。

结果

总共纳入了391名PLHIV和443名未感染艾滋病毒的个体，中位年龄分别为41岁（四分位间距36 - 48岁）和43岁（四分位间距36 - 50岁），男性分别占69.8%和65.5%。与未感染艾滋病毒的人群相比，PLHIV中由IGRA和/或TST阳性定义的LTBI患病率更高（20.5%对15.3%；比值比1.42；95%置信区间1.02 - 2.03；P = 0.04）。IGRA和TST之间的一致性一般：kappa = 0.23（95%置信区间0.09 - 0.34）。在多变量分析中，所有参与者中与注射吸毒（IDU）相关（调整后比值比2.25，95%置信区间1.27 - 3.99，P = 0.01）和监禁相关（调整后比值比1.99，95%置信区间1.13 - 3.52，P = 0.02），PLHIV中与IDU相关（调整后比值比2.37，95%置信区间1.09 - 5.15；P = 0.029），未感染艾滋病毒个体中与活动性结核病患者接触史相关（调整后比值比3.