Akpata Robert, Ntakpe Jean-Baptiste, Messou Eugène, De Castro Nathalie, Chazallon Corine, Timana Isabel, Escada Rodrigo, Cardoso Sandra Wagner, Bhatt Nilesh, Khosa Celso, Laureillard Didier, Do Chau Giang, Nogbou Frédéric Ello, Glao Donald Diomande, Veloso Valdilea, Molina Jean-Michel, Grinsztejn Beatriz, Zannou Marcel, Eholie Serge, Marcy Olivier
University of Bordeaux, National Institute for Health and Medical Research (Inserm) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Centre, 146 Rue Léo Saignat, Bordeaux, 33000, France.
Programme PACCI/ANRS Research Center, Abidjan, Côte d'Ivoire.
BMC Infect Dis. 2025 May 14;25(1):695. doi: 10.1186/s12879-025-10986-4.
Tuberculosis is a severe disease, not only due to its lethality but also to a significant morbidity occurring in people living with HIV (PLWH). If factors associated to mortality, severe morbidity and unsuccessful treatment related to the host are well identified in PLWH, there is scarce knowledge on factors related to the disease itself such as bacillary load, extent of lung involvement and disease dissemination to other organs. We sought to assess whether tuberculosis-related factors were associated with key patient outcomes in PLWH using data from an international clinical trial.
We conducted a secondary analysis of the ANRS 12300 Reflate TB2, an international phase III open-label randomized trial that assessed different antiretroviral regimens in PLWH treated for tuberculosis. We evaluated whether bacillary load (smear positivity grade), extent of lung involvement (cavitation on chest x-ray) and disease dissemination (urine LAM positivity) were associated with mortality using Cox proportional hazard models, and to severe morbidity and unsuccessful tuberculosis treatment using logistic regressions.
Of 457 participants included in this study, 90 (20.4%) had grade 2 + or 3 + smear positivity, 39 (10.8%) had cavitation on chest X-ray, and 147 (32.2%) had a positive urinary LAM. Overall, 19 (4.2%) participants died, 113 (24.7%) presented severe morbidity, and 33 (7.2%) had unsuccessful tuberculosis treatment. Factors that remained independently associated with mortality were cavitation on chest x-ray (aHR = 7.92, 95% CI, 1.74-35.94, p = .0073) and LAM positivity (aHR = 5.53, 95% CI, 1.09-28.06, p = .0389). The only factor that remained significantly associated with severe morbidity was LAM positivity (aOR = 2.04, 95% CI, 1.06-3.92, p = .0323). No factor remained significantly associated with unsuccessful tuberculosis treatment.
In PLWH with tuberculosis enrolled in a trial, tuberculosis disease characteristics related to disease severity were cavitation on chest x-ray and urine LAM positivity. Early identification of these factors could help improve the management of PLWH with tuberculosis and improve their survival.
结核病是一种严重疾病，不仅因其致死性，还因其在艾滋病毒感染者（PLWH）中引发的显著发病率。虽然与艾滋病毒感染者死亡率、严重发病率及治疗失败相关的宿主因素已得到充分认识，但对于与疾病本身相关的因素，如细菌载量、肺部受累程度及疾病向其他器官的播散，了解却很少。我们试图利用一项国际临床试验的数据，评估结核病相关因素是否与艾滋病毒感染者的关键患者结局相关。
我们对ANRS 12300 Reflate TB2进行了二次分析，这是一项国际III期开放标签随机试验，评估了接受结核病治疗的艾滋病毒感染者的不同抗逆转录病毒治疗方案。我们使用Cox比例风险模型评估细菌载量（涂片阳性分级）、肺部受累程度（胸部X线片上的空洞形成）和疾病播散（尿液脂阿拉伯甘露聚糖阳性）是否与死亡率相关，并使用逻辑回归评估其与严重发病率和结核病治疗失败的关系。
本研究纳入的457名参与者中，90名（20.4%）涂片阳性分级为2级及以上或3级及以上，39名（10.8%）胸部X线片有空洞形成，147名（32.2%）尿液脂阿拉伯甘露聚糖阳性。总体而言，19名（4.2%）参与者死亡，113名（24.7%）出现严重发病率，33名（7.2%）结核病治疗失败。与死亡率独立相关的因素是胸部X线片有空洞形成（调整后风险比[aHR]=7.92，95%置信区间[CI]为1.74 - 35.94，p = 0.0073）和脂阿拉伯甘露聚糖阳性（aHR = 5.53，95% CI为1.09 - 28.06，p = 0.0389）。与严重发病率仍显著相关的唯一因素是脂阿拉伯甘露聚糖阳性（调整后比值比[aOR]=2.04，95% CI为1.06 - 3.92，p = 0.0323）。没有因素与结核病治疗失败仍显著相关。
在参与试验的艾滋病毒感染结核病患者中，与疾病严重程度相关的结核病疾病特征是胸部X线片有空洞形成和尿液脂阿拉伯甘露聚糖阳性。早期识别这些因素有助于改善艾滋病毒感染结核病患者的管理并提高其生存率。
