Antonucci G, Girardi E, Raviglione M C, Ippolito G
Centro di Riferimento AIDS, Ospedale L. Spallanzani, Rome, Italy.
JAMA. 1995 Jul 12;274(2):143-8. doi: 10.1001/jama.274.2.143.
To analyze how demographic, clinical, and laboratory characteristics influence the risk of tuberculosis in human immunodeficiency virus (HIV)-infected individuals; to examine the incidence of tuberculosis associated with change in skin test responsiveness in HIV-infected, tuberculin-negative, nonanergic individuals.
Multicenter cohort study.
Twenty-three infectious disease units in public hospitals in Italy.
A consecutive sample of 3397 HIV-infected subjects were considered for entry in the study. Of these, 2695 who were followed up for at least 4 weeks were enrolled in the study; 739 subjects (27.4%) were unavailable for follow-up. The median duration of follow-up was 91 weeks.
Culture-proven tuberculosis.
Eighty-three episodes of tuberculosis were observed. Incidence rates of tuberculosis were 5.42 per 100 person-years among tuberculin-positive subjects, 3.00 per 100 person-years among anergic subjects, and 0.45 per 100 person-years among tuberculin-negative nonanergic subjects. In multivariate analysis, being tuberculin-positive (hazard ratio [HR], 9.94; 95% confidence interval [CI], 3.84 to 25.72) or anergic (HR, 3.35; 95% CI, 1.40 to 8.00), or having a CD4+ lymphocyte count less than 0.20 x 10(9)/L (HR, 4.87; 95% CI, 2.35 to 10.11) or between 0.20 and 0.35 x 10(9)/L (HR, 2.35; 95% CI, 1.09 to 5.05) were statistically significantly associated with the risk of tuberculosis. Incidence of tuberculosis increased with decreasing levels of CD4+ lymphocytes in the three groups of subjects with different skin test responsiveness. Skin tests were repeated 1 year after enrollment in 604 tuberculin-negative nonanergic subjects; three case of tuberculosis were observed among the 13 subjects who converted to tuberculin reactivity.
Risk of tuberculosis in HIV-infected persons can be more precisely quantified by jointly considering skin test reactivity and CD4+ lymphocyte count. Periodic skin tests in tuberculin-negative nonanergic individuals can be useful in identifying individuals at high risk of active tuberculosis.
分析人口统计学、临床和实验室特征如何影响人类免疫缺陷病毒（HIV）感染者患结核病的风险；研究在HIV感染、结核菌素阴性、无反应性个体中，与皮肤试验反应性变化相关的结核病发病率。
多中心队列研究。
意大利公立医院的23个传染病科室。
连续抽取3397名HIV感染者作为研究对象。其中，2695名接受至少4周随访的患者被纳入研究；739名患者（27.4%）无法进行随访。随访的中位时间为91周。
经培养证实的结核病。
观察到83例结核病发作。结核菌素阳性受试者的结核病发病率为每100人年5.42例，无反应性受试者为每100人年3.00例，结核菌素阴性无反应性受试者为每100人年0.45例。多因素分析显示，结核菌素阳性（风险比[HR]，9.94；95%置信区间[CI]，3.84至25.72）或无反应性（HR，3.35；95%CI，1.40至8.00），或CD4+淋巴细胞计数低于0.20×10⁹/L（HR，4.87；95%CI，2.35至10.11）或在0.20至0.35×10⁹/L之间（HR，2.35；95%CI，1.09至5.05）与结核病风险在统计学上显著相关。在三组具有不同皮肤试验反应性的受试者中，结核病发病率随CD4+淋巴细胞水平降低而增加。在604名结核菌素阴性无反应性受试者入组1年后重复进行皮肤试验；在13名转为结核菌素反应阳性的受试者中观察到3例结核病。
联合考虑皮肤试验反应性和CD4+淋巴细胞计数可更精确地量化HIV感染者患结核病的风险。对结核菌素阴性无反应性个体定期进行皮肤试验有助于识别活动性结核病高危个体。
