Luo C, Chintu C, Bhat G, Raviglione M, Diwan V, DuPont H L, Zumla A
Department of Paediatrics, University Teaching Hospital, Lusaka, Zambia.
Tuber Lung Dis. 1994 Apr;75(2):110-5. doi: 10.1016/0962-8479(94)90039-6.
This study was conducted at the Department of Paediatrics and Child Health, University Teaching Hospital (UTH), in Lusaka, Zambia.
To monitor the seroprevalence of HIV type-1 in children with tuberculosis and to evaluate the response to anti-tuberculosis therapy using a thioacetazone-free treatment regimen.
A prospective cross-sectional study of all consecutive newly diagnosed cases of TB in children from 1 month-15 years of age seen at the University Teaching Hospital (UTH) in Lusaka, Zambia between 1 October 1991 and 31 May 1992.
120 children with a clinical diagnosis of tuberculosis and 167 controls were enrolled in the study. The overall HIV type-1 seroprevalence rate in children with tuberculosis was 55.8% (67/120) compared to 9.6% (16/167) amongst the control group (P < 0.0001: odds ratio = 11.50; 95% CI = 5.99-22.7). Common clinical presentations among children with TB were bronchopneumonia (45/162), miliary TB (30/162) and tuberculous lymphadenopathy (21/33). There were no significant differences in clinical presentation of TB between the HIV-negative and HIV-positive groups. The follow-up of those patients with tuberculosis was poor, with only 65 patients (55%) returning to the clinic for scheduled appointments after discharge. All the 16 patients who died did so within 60 days of discharge from hospital; all of them were seropositive for HIV. There were no deaths among the HIV-negative group. Despite the exclusion of thioacetazone from the treatment regimen, cutaneous reactions occurring within 8 weeks of commencing treatment were observed in 7 of the 65 (11%) patients, 2 of whom developed fatal Stevens-Johnson syndrome. All 7 patients were seropositive for HIV-1.
The seroprevalence rate of HIV type-1 among children with tuberculosis in Lusaka continues to rise; careful monitoring of anti-TB therapy (even in regimens excluding thioacetazone) for potentially lethal side effects should be carried out.
本研究在赞比亚卢萨卡大学教学医院儿科与儿童健康科开展。
监测结核病患儿中1型人类免疫缺陷病毒（HIV-1）的血清阳性率，并使用不含氨硫脲的治疗方案评估抗结核治疗的反应。
对1991年10月1日至1992年5月31日期间在赞比亚卢萨卡大学教学医院就诊的所有连续新诊断的1个月至15岁儿童结核病病例进行前瞻性横断面研究。
120例临床诊断为结核病的儿童和167例对照纳入研究。结核病患儿中HIV-1的总体血清阳性率为55.8%（67/120），而对照组为9.6%（16/167）（P<0.0001；优势比=11.50；95%置信区间=5.99 - 22.7）。结核病患儿常见的临床表现为支气管肺炎（45/162）、粟粒性结核病（30/162）和结核性淋巴结病（21/33）。HIV阴性和HIV阳性组结核病的临床表现无显著差异。这些结核病患者的随访情况不佳，出院后只有65例患者（55%）返回诊所进行预约复诊。16例死亡患者均在出院后60天内死亡；他们均为HIV血清阳性。HIV阴性组无死亡病例。尽管治疗方案中排除了氨硫脲，但在开始治疗的8周内，65例患者中有7例（11%）出现皮肤反应，其中2例发展为致命的史蒂文斯-约翰逊综合征。所有7例患者HIV-1血清均为阳性。
卢萨卡结核病患儿中HIV-1的血清阳性率持续上升；应密切监测抗结核治疗（即使是不含氨硫脲的方案）是否存在潜在致命副作用。
