The impact of human immunodeficiency virus infection on drug-resistant tuberculosis
The impact of human immunodeficiency virus infection on drug-resistant tuberculosis
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DOI：
10.1164/ajrccm.154.5.8912768
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发表时间：
1996-11-01
影响因子：
24.7
通讯作者：
Groom, C
中科院分区：
文献类型：
--
作者：
Gordin, FM;Nelson, ET;Groom, C
感染人类免疫缺陷病毒(HIV)与纽约市地区耐单一和多药耐药(MDR)结核病的发病率增加有关。为了检查HIV感染与美国其他选定地区耐药结核病的关系，我们建立了培养证实的结核病病例登记。数据是从NIH资助的、基于社区的HIV临床试验小组的参与地点收集的。记录了1992年1月至1994年6月期间发生的所有结核病病例，不论其艾滋病毒状况如何。总体而言，评估了1373例结核病病例，其中425例来自纽约市地区，948例来自其他七个大都市地区。对一种或多种药物的耐药率为20.4%，5.6%的分离株同时对异烟肼和利福平耐药。在纽约市地区，感染艾滋病毒的患者比不知道感染艾滋病毒的人更有可能对至少一种药物(37%对19%)和MDR(19%对6%)产生抗药性。在其他地区，总体耐药率为16%，只有2.2%的分离株为多药耐药。在多元Logistic回归分析中，HIV感染是耐药结核病的危险因素，与地理位置、既往治疗史、年龄和种族无关。我们的结论是，无论是在纽约市地区还是在其他地理区域，艾滋病毒感染都与抗结核药物耐药性的增加有关。耐多药结核病主要发生在纽约市地区，与艾滋病毒感染高度相关。
infection with human immunodeficiency virus (HIV) has been associated with increased rates of single- and multidrug-resistant (MDR) tuberculosis in the New York City area. In order to examine the relationship of HIV infection to drug-resistant tuberculosis in other selected regions of the United States, we established a registry of cases of culture-proven tuberculosis. Data were collected from sites participating in an NIH-funded, community-based HIV clinical trials group. All cases of tuberculosis, regardless of HIV status, which occurred between January 1992 and June 1994 were recorded. Overall, 1,373 cases of tuberculosis were evaluated, including 425 from the New York City area, and 948 from seven other metropolitan areas. The overall prevalence of resistance to one or more drugs was 20.4%, and 5.6% of isolates were resistant to both isoniazid and rifampin (MDR). In the New York City area, HIV-infected patients were significantly more likely than persons not known to be HIV-infected, to have resistance to at least one drug (37% versus 19%) and MDR (19% versus 6%). In other geographic areas, overall drug resistance was 16%, and only 2.2% of isolates were MDR. In multiple logistic regression analyses, HIV infection was shown to be a risk factor for drug-resistant tuberculosis, independent of geographic location, history of prior therapy, age, and race. We concluded that HIV infection is associated with increased rates elf resistance to antituberculosis drugs in both the New York City area and other geographic areas. MDR tuberculosis is occurring predominantly in the New York City area and is highly correlated with HIV infection.