乌干达坎帕拉未接受抗逆转录病毒治疗的艾滋病毒感染者中结核病系统筛查的性别差异。

Sex differences in systematic screening for tuberculosis among antiretroviral therapy naïve people with HIV in Kampala, Uganda.

作者信息

Chaisson Lelia H, Semitala Fred C, Mwebe Sandra, Scully Eileen P, Katende Jane, Asege Lucy, Nakaye Martha, Andama Alfred O, Cattamanchi Adithya, Yoon Christina

机构信息

UCSF Center for Tuberculosis, University of California, San Francisco, San Francisco, CA, USA.

UCSF Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA.

出版信息

BMC Infect Dis. 2025 Apr 1;25(1):452. doi: 10.1186/s12879-025-10835-4.

DOI:10.1186/s12879-025-10835-4

PMID:40169948

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11963461/

Abstract

BACKGROUND

Systematic tuberculosis (TB) screening is recommended for all people with HIV (PWH) because of its potential to improve TB outcomes through earlier diagnosis and treatment initiation. As such, systematic screening may be particularly important for men, who experience excess TB prevalence and mortality compared to women. We assessed sex differences among PWH undergoing systematic TB screening, including TB prevalence and severity, diagnostic accuracy of screening tools, and TB outcomes.

METHODS

We enrolled and followed adults with HIV (CD4 ≤ 350 cells/µL) initiating antiretroviral therapy (ART) at two HIV/AIDS clinics in Uganda from July 2013 to December 2016. All participants underwent TB screening and sputum collection for TB testing (Xpert MTB/RIF [Xpert], culture). We evaluated diagnostic accuracy of four WHO-recommended TB screening strategies (symptom screen; C-reactive protiein [CRP]; symptom screen followed by CRP, if symptomatic [symptoms + CRP]; Xpert) for culture-positive TB and compared TB prevalence, days-to-treatment initiation, and 3-month mortality by sex.

RESULTS

Of 1,549 participants, 727 (46.9%) were male and 236 (15.2%) had culture-positive TB. Compared to females, males had lower pre-ART CD4 counts (median 139 vs. 183 cells/µL, p < 0.001), higher TB prevalence (20.5% vs. 10.6%, p < 0.001), and higher mycobacterial load as measured by Xpert semi-quantitative grade (p = 0.03). Sensitivity was high (≥ 89.8%) for all screening strategies except Xpert (Xpert sensitivity 57.2%) and did not differ by sex. Specificity varied widely from 13.9% for symptom screen to 99.2% for Xpert, and was 5-15% lower for males than females for symptom screen, CRP, and symptoms + CRP. Among PWH with culture-positive TB, median days-to-treatment initiation (2 vs. 4, p = 0.13) and 3-month mortality (9.4% vs. 9.2%, p = 0.96) were similar for males and females.

CONCLUSIONS

Although ART-naïve males undergoing systematic screening had more advanced HIV and TB than females, days-to-TB treatment initiation and early TB mortality were similar, suggesting that systematic TB screening has the potential to reduce sex-based disparities in TB outcomes.

摘要

背景

由于系统性结核病（TB）筛查有可能通过早期诊断和开始治疗来改善结核病结局，因此建议对所有艾滋病毒感染者（PWH）进行筛查。因此，系统性筛查对男性可能尤为重要，因为与女性相比，男性结核病患病率和死亡率更高。我们评估了接受系统性结核病筛查的艾滋病毒感染者之间的性别差异，包括结核病患病率和严重程度、筛查工具的诊断准确性以及结核病结局。

方法

2013年7月至2016年12月，我们在乌干达的两家艾滋病毒/艾滋病诊所招募并随访了开始接受抗逆转录病毒治疗（ART）的成年艾滋病毒感染者（CD4≤350个细胞/微升）。所有参与者都接受了结核病筛查并采集痰液进行结核病检测（Xpert MTB/RIF [Xpert]、培养）。我们评估了世界卫生组织推荐的四种结核病筛查策略（症状筛查；C反应蛋白[CRP]；有症状时先进行症状筛查，然后进行CRP[症状+CRP]；Xpert）对培养阳性结核病的诊断准确性，并比较了按性别划分的结核病患病率、开始治疗的天数和3个月死亡率。

结果

在1549名参与者中，727名（46.9%）为男性，236名（15.2%）患有培养阳性结核病。与女性相比，男性ART前CD4细胞计数较低（中位数139对183个细胞/微升，p<0.001），结核病患病率较高（20.5%对10.6%，p<0.001），Xpert半定量分级测量的分枝杆菌载量较高（p=0.03）。除Xpert外（Xpert敏感性57.2%），所有筛查策略的敏感性都很高（≥89.8%），且不存在性别差异。特异性差异很大，从症状筛查的13.9%到Xpert的99.2%，症状筛查、CRP和症状+CRP的男性特异性比女性低5%-15%。在培养阳性结核病的艾滋病毒感染者中，男性和女性开始治疗的中位数天数（2对4，p=0.13）和3个月死亡率（9.4%对9.2%，p=0.96）相似。