Guelar A, Gatell J M, Verdejo J, Podzamczer D, Lozano L, Aznar E, Miró J M, Mallolas J, Zamora L, González J
Infectious Disease Unit, Hospital Clinic, Barcelona, Spain.
AIDS. 1993 Oct;7(10):1345-9. doi: 10.1097/00002030-199310000-00007.
To evaluate the risk of developing active tuberculosis (TB) in a cohort of HIV-1-infected patients.
Prospective longitudinal follow-up of 839 HIV-infected patients, of whom 505 (60%) were parenteral drug users and 269 (32%) homosexual men. Tuberculin skin tests were performed at baseline and annually thereafter. Prophylaxis with isoniazid (300 mg daily for 9 months) was offered to those with a positive tuberculin test (induration > or = 5 mm). Diagnosis of TB was accepted if it could be confirmed microbiologically (acid-fast bacilli seen in Ziehl-Neelsen stains or grown in Lowenstein-Jensen cultures) or pathologically (presence of caseating granulomas) and patients had consistent clinical manifestations.
Active TB developed in 23 out of the 733 (3.1%) patients with a negative tuberculin skin test after a mean follow-up of 16 +/- 11 months (range, 2-52 months), with an estimated cumulative probability of 1.5 and 7% after 1 and 3 years, respectively (or 2.4 per 100 patient-years). None of the 87 patients with a negative tuberculin test but a positive Multitest developed TB. Conversely, 106 patients had a positive tuberculin skin test (97 at baseline and nine who converted during follow-up). Active TB developed in seven out of the 26 not receiving prophylaxis or in whom prophylaxis had to be discontinued (16.2 per 100 patient-years), in four out of 61 patients 3-27 months after having completed 9 months of prophylaxis with isoniazid (8.9 per 100 patient-years) and in none of the 19 still receiving isoniazid. When TB was diagnosed, the mean CD4 lymphocyte count of the 34 patients who developed it during follow-up was 77 +/- 103 x 10(6)/l (range, 1-400 x 10(6)/l).
Among HIV-infected patients in whom the tuberculin skin test is negative, the risk of developing active TB is sufficient to consider prophylaxis if the CD4 count falls below 400 x 10(6)/l, at least in those patients with skin anergy living in high-risk geographical areas such as Spain. When the tuberculin skin test was positive, isoniazid (9 months) provided a 45% protection beyond the period of its administration.
评估一组感染人类免疫缺陷病毒1型（HIV-1）患者发生活动性结核病（TB）的风险。
对839例HIV感染患者进行前瞻性纵向随访，其中505例（60%）为静脉吸毒者，269例（32%）为男同性恋者。在基线时及此后每年进行结核菌素皮肤试验。对结核菌素试验阳性（硬结≥5mm）者给予异烟肼预防性治疗（每日300mg，持续9个月）。如果TB的诊断能够通过微生物学方法（在萋-尼氏染色中见到抗酸杆菌或在罗-琴培养基中生长）或病理学方法（存在干酪样肉芽肿）得到证实，且患者有一致的临床表现，则可确诊。
733例结核菌素皮肤试验阴性的患者中，有23例（3.1%）在平均随访16±11个月（范围2 - 52个月）后发生活动性TB，估计1年和3年后的累积概率分别为1.5%和7%（或每100患者年2.4例）。87例结核菌素试验阴性但多重试验阳性的患者均未发生TB。相反，106例患者结核菌素皮肤试验阳性（97例在基线时阳性，9例在随访期间转为阳性）。26例未接受预防性治疗或不得不停止预防性治疗的患者中有7例发生活动性TB（每100患者年16.2例），61例在完成9个月异烟肼预防性治疗3 - 27个月后有4例发生（每100患者年8.9例），19例仍在接受异烟肼治疗的患者中无1例发生。在随访期间发生TB的34例患者诊断时，其平均CD4淋巴细胞计数为77±103×10⁶/L（范围1 - 400×10⁶/L）。
在结核菌素皮肤试验阴性的HIV感染患者中，如果CD4计数降至400×10⁶/L以下，发生活动性TB的风险足以考虑进行预防性治疗，至少对于生活在西班牙等高风险地理区域且有皮肤无反应性的患者如此。当结核菌素皮肤试验阳性时，异烟肼（9个月）在其给药期之后提供了45%的保护作用。
