欧洲获得性免疫缺陷综合征患者中的结核病。欧洲艾滋病研究小组。

Tuberculosis among European patients with the acquired immune deficiency syndrome. The AIDS in Europe Study Group.

作者信息

Sudre P, Hirschel B J, Gatell J M, Schwander S, Vella S, Katlama C, Ledergerber B, d'Arminio Monforte A, Goebel F D, Pehrson P O, Pedersen C, Lundgren J D

机构信息

Division de Maladies Infectieuses, Hôpital Cantonal Universitaire, Genève, Switzerland.

出版信息

Tuber Lung Dis. 1996 Aug;77(4):322-8. doi: 10.1016/s0962-8479(96)90096-9.

DOI:10.1016/s0962-8479(96)90096-9

PMID:8796247

Abstract

OBJECTIVES

To describe the characteristics of acquired immune deficiency syndrome (AIDS) patients with tuberculosis in Europe; to assess the incidence and risk factors of tuberculosis after AIDS; to compare survival of AIDS patients with and without extra-pulmonary tuberculosis (EPTB) at the time of AIDS diagnosis.

DESIGN

Multicentric retrospective cohort study of 6544 AIDS patients diagnosed in 52 clinical centres and 17 European countries.

METHODS

Description of patient characteristics and comparisons of tuberculosis incidence and mortality after AIDS with multivariate Cox proportional hazard models.

RESULTS

14.6% of AIDS patients had tuberculosis and 78% of those with tuberculosis had EPTB. EPTB was the AIDS-defining condition in 8.7% of the patients. Tuberculosis incidence after AIDS was 3.1 per 100 person-years. Age, gender and HIV-transmission category were not significantly associated with an increased risk of tuberculosis and the strongest risk factor for both EPTB and pulmonary tuberculosis (PTB) was the region of origin. The adjusted hazard ratio of EPTB and PTB in Southern Europe compared to Northern Europe were 5.5 (95% confidence interval [CI]: 5.0-6.1) and 2.0 (CI: 1.4-2.7) respectively. The apparent survival advantage of AIDS patients with EPTB compared to patients diagnosed with other conditions (median survival time: 22 vs 16 months) was statistically not significant when confounding variables were adjusted for (Hazard ratio: 0.85; CI: 0.62-1.07).

CONCLUSIONS

In Europe, there are large differences in the incidence of tuberculosis among AIDS patients in different countries. They do not seem to be due to differences in age or in the prevalence of injecting drug use and likely reflect differences in the prevalence of tuberculosis infection. The role of recent transmission should also be considered, and national tuberculosis control efforts and Europe-wide surveillance need to be reinforced accordingly.

摘要

目的

描述欧洲获得性免疫缺陷综合征（AIDS）合并结核病患者的特征；评估AIDS后结核病的发病率及危险因素；比较AIDS诊断时合并和未合并肺外结核（EPTB）的AIDS患者的生存率。

设计

对在17个欧洲国家52个临床中心诊断的6544例AIDS患者进行多中心回顾性队列研究。

方法

描述患者特征，并采用多变量Cox比例风险模型比较AIDS后结核病的发病率和死亡率。

结果

14.6%的AIDS患者患有结核病，其中78%的结核病患者患有EPTB。EPTB是8.7%患者的AIDS定义疾病。AIDS后结核病发病率为每100人年3.1例。年龄、性别和HIV传播类别与结核病风险增加无显著相关性，EPTB和肺结核（PTB）的最强危险因素是原籍地区。与北欧相比，南欧EPTB和PTB的校正风险比分别为5.5（95%置信区间[CI]：5.0 - 6.1）和2.0（CI：1.4 - 2.7）。当对混杂变量进行校正后，与诊断为其他疾病的患者相比，合并EPTB的AIDS患者的明显生存优势（中位生存时间：22个月对16个月）在统计学上无显著意义（风险比：0.85；CI：0.62 - 1.07）。