Sterling T R, Moore R D, Graham N M, Astemborski J, Vlahov D, Chaisson R E
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA.
AIDS. 1998 Aug 20;12(12):1451-7. doi: 10.1097/00002030-199812000-00006.
To determine the relationship between Mycobacterium tuberculosis infection and disease and subsequent disseminated M. avium complex (MAC) disease in HIV-infected persons.
A prospective observational cohort study.
The AIDS Linked to the Intravenous Experience (ALIVE) cohort of injecting drug users and the Johns Hopkins Hospital Adult HIV Clinic (JHHAHC).
HIV-infected persons aged > 18 years with CD4 lymphocytes < 100 x 10(6)/l were followed between July 1989 and 31 October 1996. There were 182 persons in the ALIVE cohort and 1129 persons in JHHAHC who met these criteria.
The relative risk of disseminated MAC was determined according to a history of prior opportunistic infection, MAC prophylaxis, antiretroviral therapy, M. tuberculosis infection or disease, race, sex, and injecting drug use.
Amongst the 30 patients with active tuberculosis, eight developed disseminated MAC, compared with 208 cases of disseminated MAC amongst 1148 patients without prior M. tuberculosis infection or disease [relative risk (RR), 1.5; 95% confidence interval (CI), 0.8-2.7; P=0.2]. Amongst the 10 patients with extrapulmonary tuberculosis, five developed disseminated MAC (RR, 2.8; 95% CI, 1.5-5.2; P=0.02). Injecting drug use was associated with a decreased risk of disseminated MAC (RR, 0.7; 95% CI, 0.6-0.9; P=0.007). In a logistic regression analysis, disseminated MAC was significantly associated with extrapulmonary tuberculosis and other opportunistic disease, whereas antibiotic prophylaxis and injecting drug use were protective.
A history of M. tuberculosis infection or disease was not associated with protection against subsequent disseminated MAC disease in HIV-infected persons. However, persons with extrapulmonary tuberculosis were at increased risk for disseminated MAC, particularly at low CD4 cell levels.
确定结核分枝杆菌感染及疾病与随后HIV感染者发生播散性鸟分枝杆菌复合体（MAC）病之间的关系。
一项前瞻性观察队列研究。
静脉注射吸毒者的艾滋病与静脉注射经历（ALIVE）队列以及约翰霍普金斯医院成人HIV诊所（JHHAHC）。
1989年7月至1996年10月31日期间对年龄大于18岁、CD4淋巴细胞<100×10⁶/l的HIV感染者进行随访。ALIVE队列中有182人，JHHAHC中有1129人符合这些标准。
根据既往机会性感染史、MAC预防、抗逆转录病毒治疗、结核分枝杆菌感染或疾病史、种族、性别及静脉注射吸毒情况确定播散性MAC的相对风险。
在30例活动性结核病患者中，8例发生播散性MAC，而在1148例无既往结核分枝杆菌感染或疾病的患者中有208例发生播散性MAC[相对风险（RR），1.5；95%置信区间（CI），0.8 - 2.7；P = 0.2]。在10例肺外结核患者中，5例发生播散性MAC（RR，2.8；95%CI，1.5 - 5.2；P = 0.02）。静脉注射吸毒与播散性MAC风险降低相关（RR，0.7；95%CI，0.6 - 0.9；P = 0.007）。在逻辑回归分析中，播散性MAC与肺外结核及其他机会性疾病显著相关，而抗生素预防和静脉注射吸毒具有保护作用。
结核分枝杆菌感染或疾病史与HIV感染者预防随后发生的播散性MAC病无关。然而，肺外结核患者发生播散性MAC的风险增加，尤其是在CD4细胞水平较低时。
