Tuberculosis-associated immune reconstitution disease: incidence, risk factors and impact in an antiretroviral treatment service in South Africa
Tuberculosis-associated immune reconstitution disease: incidence, risk factors and impact in an antiretroviral treatment service in South Africa
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DOI：
10.1097/qad.0b013e328011efac
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发表时间：
2007-01-30
期刊：
影响因子：
3.8
通讯作者：
Wood, Robin
中科院分区：
文献类型：
--
作者：
Lawn, Stephen D.;Myer, Landon;Wood, Robin
目的：为了确定结核病（TB）相关的免疫重建疾病（IRD）的负担和影响，在撒哈拉以南Africa.Design中开始抗逆转录病毒治疗（ART）的患者中，对一项研究队列进行回顾性分析，该研究队列在以社区为基础的ART service in SouthAfrica.Methods中招募了3年以上，研究了在ART开始时接受TB治疗的患者（n = 160）。结果：基线CD 4细胞计数中位数为68个细胞/μ l [四分位数间距（IQR），29-133个细胞/μ l]，ART在TB诊断后中位数105天（IQR，61 - 164天）后开始。虽然IRD仅在12%（n = 19）的患者中被诊断出来，但在结核病诊断后2个月内开始ART的患者中，有32%（n = 12）发生了IRD。84%（n = 16）观察到肺部受累，腹腔内表现也很常见（37%）。总体而言，4%（n = 7）的队列需要二级医疗保健的IRD和两名（1%）患者死亡。在多变量分析中，[RD]风险与早期ART启动和低基线CD 4细胞计数密切相关。在CD 4计数< 50个细胞/μ l的患者中，在结核病诊断后0-30、31-60、61-90、91-120和> 120天内开始抗逆转录病毒治疗后发生IRD的比例分别为100%、33%、14%、7%和0%。在这种情况下，对于那些在抗结核治疗早期开始ART的基线CD 4细胞计数较低的患者，TB相关IRD的风险非常高。然而，大多数病例是自限性的;整体二级卫生保健利用率和IRD的死亡风险较低。(c)2007年利平科特威廉姆斯&威尔金斯。
Objective: To determine the burden and impact of immune reconstitution disease (IRD) associated with tuberculosis (TB) among patients initiating antiretroviral treatment (ART) in sub-Saharan Africa.Design: Retrospective analysis of a study cohort enrolled over 3 years within a community-based ART service in South Africa.Methods: Patients receiving treatment for TB at the time ART was initiated (n = 160) were studied. Cases of TB-associated IRD during the first 4 months of ART were ascertained.Results: The median baseline CD4 cell count was 68 cells/mu l [interquartile range (IQR), 29-133 cells/mu l) and ART was initiated after a median of 105 days (IQR, 61 -164 days) from TB diagnosis. Although IRD was diagnosed in just 12% (n = 19) of patients overall, IRD developed in 32% (n = 12) of those who started ART within 2 months of TB diagnosis. Pulmonary involvement was observed in 84% (n = 16) and intra-abdominal manifestations were also common (37%). Overall, 4% (n = 7) of the cohort required secondary level health-care for IRD and two (1%) patients died. In multivariate analysis, risk of [RD was strongly associated with early ART initiation and low baseline CD4 cell count. Of patients with CD4 counts < 50 cells/mu l, the proportions who developed IRD following initiation of ART within 0-30, 31-60, 61-90, 91-120 and > 120 days of TB diagnosis were 100%, 33%, 14%, 7% and 0%, respectively.Conclusions: The risk of TB-associated IRD in this setting is very high for those with low baseline CD4 cell counts initiating ART early in the course of antituberculosis treatment. However, most cases were self-limiting; overall secondary health-care utilization and mortality risk from IRD were low. (c) 2007 Lippincott Williams & Wilkins.