Coovadia H M, Jeena P, Wilkinson D
Department of Paediatrics and Child Health, University of Natal, Durban, South Africa.
Int J Tuberc Lung Dis. 1998 Oct;2(10):844-51.
The impact of the human immunodeficiency virus (HIV) pandemic on childhood tuberculosis (TB) is unclear because of inconsistent and often contradictory findings in different types of studies. We review the evidence which supports or refutes the likelihood that HIV infection in children predisposes them to TB, and conclude that, on balance, HIV during infancy increases the risk of developing TB. Surveillance shows an association between rising TB rates among children and the HIV epidemic in some parts of the world. A number of cross-sectional studies which have taken children with TB as their starting population, have yielded high rates of association with HIV (11%-64% HIV prevalence). Similarly, cross-sectional studies of hospitalised children with HIV show that many also have TB. These rates of association are all over-estimated because of the uncertainty of diagnosis of TB. Birth cohorts of perinatally HIV-infected infants and children prospectively followed up for a few years have generally failed to detect a higher incidence of TB than anticipated. The few TB cases identified in these cohorts were usually over 15-18 months of age. In acute progressive lung disease there is no excess of TB in HIV-infected over non HIV-infected children. These inconsistencies are discussed and attributed mainly to study design and statistical artefact. However, maternal factors in HIV-positive women which might affect transmission of TB to their babies are assessed, and infant immunoparesis due to HIV which may adversely influence resistance to TB is considered.
由于不同类型研究的结果不一致且常常相互矛盾，人类免疫缺陷病毒（HIV）大流行对儿童结核病（TB）的影响尚不清楚。我们回顾了支持或反驳儿童感染HIV使其易患结核病这一可能性的证据，并得出结论，总体而言，婴儿期感染HIV会增加患结核病的风险。监测显示，在世界某些地区，儿童结核病发病率上升与HIV流行之间存在关联。一些以患结核病儿童为起始人群的横断面研究显示，与HIV的关联率很高（HIV患病率为11%-64%）。同样，对住院HIV感染儿童的横断面研究表明，许多儿童也患有结核病。由于结核病诊断的不确定性，这些关联率都被高估了。对围产期感染HIV的婴儿和儿童进行前瞻性随访数年的出生队列研究，通常未能发现结核病发病率高于预期。在这些队列中确定的少数结核病病例通常超过15-18个月大。在急性进行性肺病中，HIV感染儿童的结核病发病率并不高于未感染HIV的儿童。本文讨论了这些不一致之处，主要归因于研究设计和统计假象。此外，还评估了HIV阳性女性中可能影响结核病传播给其婴儿的母体因素，并考虑了HIV导致的婴儿免疫功能不全可能对结核病抵抗力产生的不利影响。
