Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
Office of the President and CEO, South African Medical Research Council, Cape Town, South Africa.
Environ Health. 2024 Jan 17;23(1):6. doi: 10.1186/s12940-023-01044-0.
In low- and middle-income countries countries, millions of deaths occur annually from household air pollution (HAP), pulmonary tuberculosis (PTB), and HIV-infection. However, it is unknown whether HAP influences PTB risk among people living with HIV-infection.
We conducted a case-control study among 1,277 HIV-infected adults in Bukavu, eastern Democratic Republic of Congo (February 2018 - March 2019). Cases had current or recent (<5y) PTB (positive sputum smear or Xpert MTB/RIF), controls had no PTB. Daily and lifetime HAP exposure were assessed by questionnaire and, in a random sub-sample (n=270), by 24-hour measurements of personal carbon monoxide (CO) at home. We used multivariable logistic regression to examine the associations between HAP and PTB.
We recruited 435 cases and 842 controls (median age 41 years, [IQR] 33-50; 76% female). Cases were more likely to be female than male (63% vs 37%). Participants reporting cooking for >3h/day and ≥2 times/day and ≥5 days/week were more likely to have PTB (aOR 1·36; 95%CI 1·06-1·75) than those spending less time in the kitchen. Time-weighted average 24h personal CO exposure was related dose-dependently with the likelihood of having PTB, with aOR 4·64 (95%CI 1·1-20·7) for the highest quintile [12·3-76·2 ppm] compared to the lowest quintile [0·1-1·9 ppm].
Time spent cooking and personal CO exposure were independently associated with increased risk of PTB among people living with HIV. Considering the high burden of TB-HIV coinfection in the region, effective interventions are required to decrease HAP exposure caused by cooking with biomass among people living with HIV, especially women.
在中低收入国家，每年有数百万人死于家庭空气污染（HAP）、肺结核（PTB）和 HIV 感染。然而，目前尚不清楚 HAP 是否会影响 HIV 感染者患肺结核的风险。
我们在刚果民主共和国东部布卡武对 1277 名 HIV 感染成年人进行了病例对照研究（2018 年 2 月至 2019 年 3 月）。病例为现患或近期（<5 年）肺结核（痰涂片阳性或 Xpert MTB/RIF），对照为无肺结核。通过问卷调查和随机子样本（n=270）的 24 小时个人一氧化碳（CO）在家测量来评估每日和终生 HAP 暴露情况。我们使用多变量逻辑回归来研究 HAP 和 PTB 之间的关联。
我们招募了 435 例病例和 842 例对照（中位年龄 41 岁[IQR]33-50；76%为女性）。病例中女性比例高于男性（63% vs 37%）。与每天在厨房花费时间较少的人相比，每天做饭超过 3 小时/天和每天做饭≥2 次/天和每周做饭≥5 天的人更有可能患肺结核（调整后的比值比[aOR]1.36；95%CI 1.06-1.75）。时间加权平均 24 小时个人 CO 暴露与患肺结核的可能性呈剂量依赖性相关，与最低五分位数[0.1-1.9 ppm]相比，最高五分位数[12.3-76.2 ppm]的 aOR 为 4.64（95%CI 1.1-20.7）。
做饭时间和个人 CO 暴露与 HIV 感染者患肺结核的风险增加独立相关。考虑到该地区结核-艾滋病毒合并感染的高负担，需要采取有效的干预措施来减少 HIV 感染者因使用生物质做饭而导致的 HAP 暴露，特别是女性。
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