Impact of combination antiretroviral therapy on the risk of tuberculosis among persons with HIV infection
Impact of combination antiretroviral therapy on the risk of tuberculosis among persons with HIV infection
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DOI：
10.1097/00002030-200009080-00015
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发表时间：
2000-09-08
期刊：
影响因子：
3.8
通讯作者：
Ippolito, G
中科院分区：
文献类型：
--
作者：
Girardi, E;Antonucci, G;Ippolito, G
目的：评估不同抗逆转录病毒治疗方案与hiv感染者结核病发病率之间的关系。设计：观察性、多中心、前瞻性队列研究。环境和病人：意大利共有28家传染病医院。1995年5月1日至1996年4月30日期间，共有2160名艾滋病毒感染者被考虑纳入一项关于结核病预防治疗实施情况的研究。1360名完成碱基结核菌素筛查的受试者被纳入本分析。收集了关于长期使用抗逆转录病毒疗法的信息。中位随访时间为104周，997名受试者（73.3%）完成了研究。主要结局指标：根据不同类型抗逆转录病毒治疗的活动性结核病发病率。结果：共观察到18例结核病，总发病率为0.79 / 100人-年[95%可信区间（CI）， 0.51-1.31]。结核菌素阳性和低CD4+淋巴细胞计数是与结核病风险独立相关的唯一基线变量。随访期间，637例患者接受双联合抗逆转录病毒治疗，387例患者接受三联治疗。在调整入组个体的基线特征后，与无治疗或单药治疗相比，双联合治疗的结核病相对危险度为0.16 (95% CI, 0.03-0.74)，三联治疗的相对危险度为0.08 （95% CI, 0.01-0.88）。结论：抗逆转录病毒联合治疗可显著降低艾滋病毒感染者患结核病的风险。在工业化国家，这种治疗的广泛使用可能会降低艾滋病相关结核病的发病率，可能有助于降低结核病的总发病率(C) 2000。
Objective: To assess the association between use of different antiretroviral regimens and incidence of tuberculosis among HIV-infected individuals.Design: Observational, multicenter, prospective cohort study.Setting and patients: Twenty-eight infectious diseases hospital units in Italy. A total of 2160 HIV-infected persons were considered for enrolment in a study on the implementation of tuberculosis preventive therapy between 1 May 1995 and 30 April 1996. The 1360 subjects who completed tuberculin screening at base-ii ne were included in this analysis. Information on the use of antiretroviral therapies over time was collected. The median duration of follow-up was 104 weeks and 997 subjects (73.3%) completed the study.Main outcome measure: Incidence of active tuberculosis according to different types of antiretroviral therapy.Results: Eighteen cases of tuberculosis were observed with an overall incidence rate of 0.79 per 100 person-years of observation [95% confidence interval (CI), 0.51-1.31]. Tuberculin positivity and low CD4+ lymphocyte count were the only base-line variables independently associated with the risk of tuberculosis. During follow-up, 637 patients took double combination antiretroviral therapy and 387 took triple combination therapy. After adjusting for base-line characteristics of enrolled individuals, the relative hazard of tuberculosis was 0.16 (95% CI, 0.03-0.74) for double combination therapy and 0.08 (95% CI, 0.01-0.88) for triple combination therapy compared with no therapy or monotherapy.Conclusions: Combination antiretroviral therapy significantly reduced the risk of tuberculosis in HIV-infected persons. In industrialized countries, the widespread use of this treatment may determine a decrease in the incidence of HIV-associated tuberculosis, possibly contributing to a reduction in the overall incidence of tuberculosis (C) 2000 Lippincott Williams & Wilkins.