Chemoprophylaxis for tuberculosis and survival of HIV infected patients in Brazil
Chemoprophylaxis for tuberculosis and survival of HIV infected patients in Brazil
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DOI：
10.1097/00002030-200111090-00008
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发表时间：
2001-11-09
期刊：
影响因子：
3.8
通讯作者：
Schechter, M
中科院分区：
文献类型：
--
作者：
de Pinho, AMF;Santoro-Lopes, G;Schechter, M
目的：研究结核病化疗预防对结核菌素皮试阳性的HIV感染者生存的影响。设计：前瞻性观察队列研究。地点：巴西里约热内卢一所大学医院的门诊。患者：1991年1月至1994年12月收治的297例结核菌素皮试阳性(大于或等于5 mm)患者。随访结束于1998年9月30日。干预：结核病的化学预防的使用。主要观察指标：死亡是主要的结果变量。结核病的发生被作为次要结果进行研究。结果：中位随访时间为43.6个月。128例(43%)患者使用了化学预防。化学预防措施的使用与结核病风险的降低有关(风险比，0.38；95%可信区间，0.14-1.04；P=0.05)。在调整了基线CD_4细胞计数的回归模型中，化疗预防与较长的生存期有关(风险比为0.24；95%可信区间为0.09~0.65；P=0.002)。结论：在巴西，抗结核化疗与纯蛋白衍生物阳性的艾滋病毒感染者的生存期显著延长有关。这些数据对世界上结核分枝杆菌感染高发地区艾滋病毒感染者的临床护理具有重要意义。(C)2001年，Lippincott Williams&Wilkins。
Objective: To study the impact of chemoprophylaxis for tuberculosis on the survival of HIV-infected patients with a positive tuberculin skin test.Design: Prospective observational cohort study.Setting: Outpatient clinic of a university hospital, in Rio de Janeiro, Brazil.Patients: Two-hundred and ninety-seven patients with a positive tuberculin skin test (reaction greater than or equal to 5mm) who were admitted to the cohort between January 1991 and December 1994. Follow-up ended on September 30, 1998.Intervention: The use of chemoprophylaxis for tuberculosis.Main outcome measures: Death was the primary outcome variable. The occurrence of tuberculosis was studied as a secondary outcome. Cox regression models were used in these analyses.Results: The median follow-up time was 43.6 months. Chemoprophylaxis was used by 128 (43%) of the patients. The use of chemoprophylaxis was associated with a reduction in risk for tuberculosis (hazard ratio, 0.38; 95% confidence interval, 0.14-1.04; P=0.05). In a regression model adjusted for baseline CD4 cell count, chemoprophylaxis was associated with longer survival (hazard ratio, 0.24; 95% confidence interval, 0.09-0.65; P=0.002).Conclusions: Anti-tuberculosis chemoprophylaxis was associated with a substantially prolonged survival among purified protein derivative-positive HIV-infected patients in Brazil. These data have important implications for the clinical care of patients with HIV infection in areas of the world with a high prevalence of Mycobacterium tuberculosis infection. (C) 2001 Lippincott Williams & Wilkins.