Recurrent Subclinical Tuberculosis Among Antiretroviral Therapy-Accessing Participants: Incidence, Clinical Course, and Outcomes.
Recurrent Subclinical Tuberculosis Among Antiretroviral Therapy-Accessing Participants: Incidence, Clinical Course, and Outcomes.
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DOI：
10.1093/cid/ciac185
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发表时间：
2022-10-29
期刊：
影响因子：
--
通讯作者：
Karim SA
中科院分区：
文献类型：
--
作者：
Naidoo K;Moodley MC;Hassan-Moosa R;Dookie N;Yende-Zuma N;Perumal R;Dawood H;Mvelase NR;Mathema B;Karim SA
未确诊的无症状亚临床结核病仍然是全球结核病控制的一个重大威胁，在人类免疫缺陷病毒（艾滋病毒）/艾滋病（艾滋病病毒/艾滋病）感染者中占很大比例。我们确定了在南非接受抗逆转录病毒治疗（ART）的已知既往患有结核病的艾滋病毒感染者中亚临床结核病的发病率、进展和结局。共有402名曾接受过结核病治疗的成年艾滋病病毒感染者参加了南非艾滋病研究计划中心的前瞻性TRuTH（结核病和艾滋病毒治疗后结核病复发）研究。参与者在36个月内通过每季度一次的临床和细菌学评估以及一年两次的胸部X光片进行结核病筛查。那些疑似或确诊结核病的人被转介到国家结核病规划。研究对象接受包括抗逆转录病毒治疗在内的艾滋病防治服务，结核病发病率采用Poisson回归和描述性统计分析进行估计。在402例细菌学证实的复发性结核病病例中，共发现48例（11.9%），其中包括48例亚临床结核病病例中的17例（35.4%）和48例临床结核病病例中的31例（64.5%）。年龄、性别和体重指数在亚临床、临床和非结核组之间相似。临床和亚临床TB组的总体复发TB发生率（95%置信区间[CI]）分别为2.3（1.7-3.0）、1.5（1.1-2.2）和0.9（0.5-1.4）/100人-年。在亚临床TB组中，14/17例（82.4%）仅通过TB培养确诊，11/17例（64.7%）接受TB治疗，6/17例（35.3%）自发消退TB。艾滋病毒感染者和艾滋病病毒携带者中复发性亚临床结核病的高发病率突出表明，在结核病-艾滋病毒高负担环境中，以结核病为基础的结核病筛查是不够的。未确诊的无症状亚临床结核病威胁着全球结核病控制。同样，人类免疫缺陷病毒/艾滋病感染者中复发性临床和亚临床结核病的发病率很高，这突出表明在高负担环境中以结核病为基础的结核病筛查存在不足。
Undiagnosed asymptomatic subclinical tuberculosis (TB) remains a significant threat to global TB control, accounting for a substantial proportion of cases among people living with human immunodeficiency virus (HIV)/AIDS (PLWHA). We determined incidence, progression, and outcomes of subclinical TB in antiretroviral therapy (ART)–accessing PLWHA with known previous TB in South Africa. A total of 402 adult PLWHA previously treated for TB were enrolled in the prospective Centre for the AIDS Programme of Research in South Africa TRuTH (TB Recurrence Upon TB and HIV treatment) Study. Participants were screened for TB with quarterly clinical and bacteriologic evaluation and biannual chest radiographs over 36 months. Those with suspected or confirmed TB were referred to the National TB Programme. Participants received HIV services, including ART. Incidence rate of TB was estimated using Poisson regression and descriptive statistical analyses summarized data. A total of 48 of 402 (11.9%) bacteriologically confirmed incident recurrent TB cases were identified, comprising 17 of 48 (35.4%) subclinical TB cases and 31 of 48 (64.5%) clinical TB cases. Age, sex, and body mass index were similar among subclinical, clinical, and no TB groups. Incidence rates (95% Confidence Interval [CI]) of recurrent TB overall, in clinical and subclinical TB groups were 2.3 (1.7-3.0), 1.5 (1.1-2.2), and 0.9 (0.5-1.4) per 100 person-years, respectively. In the subclinical TB group, 14 of 17 (82.4%) were diagnosed by TB culture only, 11 of 17 (64.7%) received TB treatment, and 6 of 17 (35.3%) resolved TB spontaneously. High incidence rates of recurrent subclinical TB in PLWHA highlight inadequacies of symptom-based TB screening in high TB–HIV burden settings. Undiagnosed asymptomatic subclinical tuberculosis (TB) threatens global TB control. Similarly high incidence rates of recurrent clinical and subclinical TB in people living with human immunodeficiency virus/AIDS highlight inadequacies of symptom-based TB screening in high-burden settings.
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影响因子：
10
作者：
Ralph, Anna P.;Ardian, Muhamed;Kelly, Paul M.
通讯作者：
Kelly, Paul M.
影响因子：
82.9
作者：
Esmail, Hanif;Lai, Rachel P.;Lesosky, Maia;Wilkinson, Katalin A.;Graham, Christine M.;Coussens, Anna K.;Oni, Tolu;Warwick, James M.;Said-Hartley, Qonita;Koegelenberg, Coenraad F.;Walzl, Gerhard;Flynn, JoAnne L.;Young, Douglas B.;Barry, Clifton E., III;O'Garra, Anne;Wilkinson, Robert J.
通讯作者：
Wilkinson, Robert J.
结核病的自然病史：艾滋病毒阴性患者未经治疗的肺结核的持续时间和死亡：系统评价。
影响因子：
3.7
作者：
Tiemersma EW;van der Werf MJ;Borgdorff MW;Williams BG;Nagelkerke NJ
通讯作者：
Nagelkerke NJ
DOI：
10.1183/20734735.0079-2021
发表时间：
2021-09
期刊：
Breathe (Sheffield, England)
影响因子：
--
作者：
Migliori GB;Ong CWM;Petrone L;D'Ambrosio L;Centis R;Goletti D
通讯作者：
Goletti D
影响因子：
11.8
作者：
O'Shea, Matthew K.;Koh, Gavin C. K. W.;Dedicoat, Martin
通讯作者：
Dedicoat, Martin