Buziashvili Mariana, Djibuti Mamuka, Tukvadze Nestani, DeHovitz Jack, Baliashvili Davit
Scientific Research Unit, National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia.
Department of Medicine, Tbilisi State University, Tbilisi, Georgia.
Open Forum Infect Dis. 2024 Aug 19;11(9):ofae466. doi: 10.1093/ofid/ofae466. eCollection 2024 Sep.
Tuberculosis (TB) is a leading cause of morbidity and mortality among people with HIV (PHIV) globally. Our study is the first to evaluate TB incidence and its risk factors among PHIV in the country of Georgia, where previously no data were available.
A retrospective cohort study was conducted among persons newly diagnosed with HIV in Georgia during 2019-2020. Active TB incidence was calculated within a minimum of 2-year follow-up period from HIV diagnosis. Cox proportional hazard model was used for evaluating risk factors for TB development.
The median age in the final cohort of 1165 PHIV was 38 (interquartile range, 30-48) and 76.3% were male. Twenty-nine percent of patients had a CD4 cell count <200 at HIV diagnosis and 89.9% initiated antiretroviral therapy (ART). TB incidence rate was 10/1000 person-years (p-y; 95% confidence interval [CI], 9.6-10.4), with rates being higher within several subgroups, mainly: PHIV aged 40-49 years (17.5/1 000 p-y [95% CI, 16.8-18.2]); those not receiving ART (22/1000 p-y [95% CI, 20.9-23.1]); those with CD4 < 200 at baseline (28/1000 p-y [95% CI, 27.4-28.6]); and those who developed AIDS (29.1/1 000 p-y [95% CI, 28.6-29.6]). Age (aHR, 1.2; 95% CI, 1.03-1.39; = .01) and AIDS diagnosis (aHR, 3.2; 95% CI, 3.06-27.9; = .001) were associated with TB development, whereas high CD4 count was protective against TB (aHR, 0.18; 95% CI, .06-.61; = .005).
Study results highlight an imperative role of CD4 cell count management and the need for early HIV diagnosis and timely initiation of ART to ensure an effective immune response against tuberculosis, stressing the need for further in-depth evaluation of the TB preventive treatment delivery system's efficiency and gaps.
在全球范围内，结核病（TB）是艾滋病毒感染者（PHIV）发病和死亡的主要原因。我们的研究首次评估了格鲁吉亚国内艾滋病毒感染者中的结核病发病率及其危险因素，该国此前尚无相关数据。
对2019年至2020年期间在格鲁吉亚新诊断出艾滋病毒的人群进行了一项回顾性队列研究。在自艾滋病毒诊断起至少2年的随访期内计算活动性结核病发病率。采用Cox比例风险模型评估结核病发生的危险因素。
最终队列中的1165名艾滋病毒感染者的中位年龄为38岁（四分位间距为30 - 48岁），76.3%为男性。29%的患者在艾滋病毒诊断时CD4细胞计数<200，89.9%的患者开始接受抗逆转录病毒治疗（ART）。结核病发病率为10/1000人年（p-y；95%置信区间[CI]，9.6 - 10.4），在几个亚组中发病率更高，主要包括：40 - 49岁的艾滋病毒感染者（17.5/1000 p-y [95% CI，16.8 - 18.2]）；未接受抗逆转录病毒治疗的患者（22/1000 p-y [95% CI，20.9 - 23.1]）；基线时CD4<200的患者（28/1000 p-y [95% CI，27.4 -
