Espinal M A, Reingold A L, Pérez G, Camilo E, Soto S, Cruz E, Matos N, Gonzalez G
Division of Public Health Biology and Epidemiology, School of Public Health, University of California, Berkeley, USA.
J Acquir Immune Defic Syndr Hum Retrovirol. 1996 Oct 1;13(2):155-9. doi: 10.1097/00042560-199610010-00006.
We studied human immunodeficiency virus (HIV)-seroprevalence among children with clinically diagnosed tuberculosis (TB) and compared the clinical features and response to short-term anti-TB therapy of children with and without HIV infection in Santo Domingo, Dominican Republic. Children aged 18-59 months with new-onset, clinically diagnosed TB were tested for HIV antibodies, their clinical features were recorded and their response to a standard 6-month regimen of daily isoniazid and rifampicin with daily streptomycin and pyrazinamide for the first 2 months was assessed. To increase the number of HIV-infected children with TB available for study, we also included children previously known to be HIV infected who developed new-onset TB. Eleven (5.8%) of 189 consecutively enrolled children with clinically diagnosed TB were HIV infected. Fifteen other children with previously documented HIV infection and new-onset TB were available for study, yielding 26 HIV-positive and 178 HIV-negative children with TB. Of these 204 children with clinically diagnosed TB, 25 HIV-positive and 156 HIV-negative children were successfully followed for 6 months or until death. The proportion of HIV-positive children who failed treatment was 6 (29%) of 21 as compared with only 5 (3%) of 156 HIV-negative children [relative risk = 8.9; 95% confidence interval (CI) 2.9, 26.6; p = 0.0004]. HIV-infected children with clinically diagnosed TB are substantially more likely to fail standard treatment for TB than are HIV-uninfected children. If standard treatment regimens are used in such children, response to treatment must be monitored very closely and appropriate changes in the regimen must be made expeditiously.
我们研究了临床诊断为结核病（TB）的儿童中的人类免疫缺陷病毒（HIV）血清流行率，并比较了多米尼加共和国圣多明各有和没有HIV感染的儿童的临床特征以及对短期抗结核治疗的反应。对年龄在18 - 59个月、新发病且临床诊断为结核病的儿童进行HIV抗体检测，记录其临床特征，并评估他们对标准的6个月疗程（前2个月每日使用异烟肼、利福平，每日加用链霉素和吡嗪酰胺）的反应。为了增加可供研究的合并HIV感染的结核病儿童数量，我们还纳入了先前已知感染HIV且新发病的结核病儿童。在连续入组的189例临床诊断为结核病的儿童中，有11例（5.8%）感染了HIV。另有15例先前有HIV感染记录且新发病的结核病儿童可供研究，从而得到26例HIV阳性和178例HIV阴性的结核病儿童。在这204例临床诊断为结核病的儿童中，25例HIV阳性和156例HIV阴性儿童成功随访6个月或直至死亡。HIV阳性儿童治疗失败的比例为21例中的6例（29%），而HIV阴性儿童中仅156例中的5例（3%）[相对危险度 = 8.9；95%置信区间（CI）2.9, 26.6；p = 0.0004]。临床诊断为结核病且感染HIV的儿童比未感染HIV的儿童更有可能在结核病标准治疗中失败。如果在此类儿童中使用标准治疗方案，必须密切监测治疗反应，并迅速对治疗方案做出适当调整。
