van den Broek J, Chum H J, Swai R, O'Brien R J
Ministry of Health, Tuberculosis and Leprosy Central Unit, Dar es Salaam, Tanzania.
Int J Lepr Other Mycobact Dis. 1997 Jun;65(2):203-10.
An epidemiological study of the interaction of leprosy and HIV infection in Tanzania.
To establish the prevalence of HIV infection among leprosy patients, and to measure the association of HIV and leprosy by comparing the HIV prevalence in leprosy patients and blood donors.
Testing for HIV infection in consecutively diagnosed leprosy patients (new and relapsed after MDT) in all regions in Tanzania successively for a period of 3 to 6 months during 1991, 1992 and 1993.
Out of the total estimated eligible leprosy patients, 697 patients (69%) entered the final analysis. The HIV prevalence among these leprosy patients was 12% (83/697) as compared to 6% (8960/ 158,971) in blood donors examined in Tanzania during the same period. There were no significant differences in HIV seroprevalence by age, sex, residence or type of disease. However, the adjusted odds ratio (OR) of the presence of a BCG scar was 1.9 [95% confidence interval (CI) 1.1-3.3] among HIV-positive leprosy cases compared to HIV-negative leprosy cases. Comparing leprosy cases with blood donors as controls, the logistic regression model, controlling for sex, age group and residence, showed the OR for HIV seropositivity among leprosy patients to be 2.5 (95% CI 2.0-3.2). This association existed in all strata, but was strongest in the 15-34-year age group. No difference of HIV status between multibacillary and paucibacillary leprosy could be shown to exist. The point estimate of the population attributable risk of HIV infection for leprosy was 7%.
HIV infection is associated with leprosy and might reverse the epidemiological trend of the slow decline in case notification in Tanzania if HIV infection is increasing greatly. Previous BCG vaccination loses its protection against leprosy in the presence of HIV infection. A repeated study is recommended in order to validate these findings, whereby recording of the disability grading of the cases is necessary to adjust for delay in diagnosis.
坦桑尼亚一项关于麻风病与艾滋病毒感染相互作用的流行病学研究。
确定麻风病患者中艾滋病毒感染的患病率，并通过比较麻风病患者和献血者中的艾滋病毒患病率来衡量艾滋病毒与麻风病之间的关联。
在1991年、1992年和1993年期间，连续3至6个月对坦桑尼亚所有地区连续诊断的麻风病患者（新发病例和MDT治疗后复发病例）进行艾滋病毒感染检测。
在估计符合条件的麻风病患者总数中，697名患者（69%）进入最终分析。这些麻风病患者中的艾滋病毒患病率为12%（83/697），而同期在坦桑尼亚接受检测的献血者中的患病率为6%（8960/158971）。按年龄、性别、居住地或疾病类型划分，艾滋病毒血清阳性率无显著差异。然而，与艾滋病毒阴性的麻风病病例相比，艾滋病毒阳性的麻风病病例中卡介苗疤痕的校正比值比（OR）为1.9[95%置信区间（CI）1.1 - 3.3]。以献血者为对照比较麻风病病例，在控制性别、年龄组和居住地的逻辑回归模型中，麻风病患者中艾滋病毒血清阳性的OR为2.5（95%CI 2.0 - 3.2）。这种关联在所有阶层中都存在，但在15 - 34岁年龄组中最强。未发现多菌型和少菌型麻风病之间的艾滋病毒感染状况有差异。麻风病导致艾滋病毒感染的人群归因风险点估计值为7%。
艾滋病毒感染与麻风病有关，如果艾滋病毒感染大幅增加，可能会扭转坦桑尼亚病例报告缓慢下降的流行病学趋势。在存在艾滋病毒感染的情况下，先前的卡介苗接种失去了对麻风病的保护作用。建议进行重复研究以验证这些发现，为此有必要记录病例的残疾分级以校正诊断延迟。
