Tuberculosis infection and disease in South African adolescents with perinatally acquired HIV on antiretroviral therapy: a cohort study.
Tuberculosis infection and disease in South African adolescents with perinatally acquired HIV on antiretroviral therapy: a cohort study.
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DOI：
10.1002/jia2.25671
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发表时间：
2021-03
影响因子：
6
通讯作者：
Zar HJ
中科院分区：
文献类型：
--
作者：
Frigati LJ;Wilkinson KA;le Roux S;Brown K;Ruzive S;Githinji L;Petersen W;Belard S;Cotton MF;Myer L;Zar HJ
关于患有围产期获得性艾滋病毒(APHIV)的青少年中的结核病(TB)的数据有限。我们在开普敦青少年抗逆转录病毒队列(CTAAC)中调查了结核病感染和疾病的发病率和决定因素。在2013年7月至2015年3月期间登记了在公共部门护理中接受抗逆转录病毒疗法(ART)6个月以上的9至14岁青年和年龄匹配的艾滋病毒阴性青少年，并每6个月进行一次跟踪。数据于2018年10月31日被审查。每年进行症状筛查、胸片、病毒载量、CD4计数、定量分析、痰标本检测、镜检、细菌培养和药敏试验。结核病感染的定义是>；0.35单位/毫升的QFT。结核病诊断定义为确诊(培养或Xpert结核分枝杆菌/RIF阳性)或未确诊(临床诊断和开始结核病治疗)。分析检查了结核病感染和疾病的发病率和决定因素。总共有496名艾滋病毒阳性和103名艾滋病毒阴性参与者(登记时的中位年龄为12岁(四分位数范围，IQR 10.6至13.3))被跟踪的中位数为3.1年(IQR 3.0至3.4)；50%(298/599)为男性。APHIV开始抗逆转录病毒治疗的年龄中位数为4.4岁(IQR 2.1至7.6)。登记时，376/496(76%)的HIV病毒载量和40拷贝/毫升，CD4中位数为713个/mm3,179/559(32%)为QFT+，没有艾滋病毒状况的差异(APHIV154/468，33%；HIV阴性25/91，27%；P=0.31)。累积QFT+感染率相似(APHIV225/492，46%；95%可信区间41%~50%；HIV阴性44/98，45%；95%可信区间35%~55%；P=0.88)。与HIV阴性青少年相比，APHIV儿童结核病发病率较高(2.2/100Py，95%CI 1.6~3.1 vs.0.3/100Py，95%CI 0.04~2.2；IRR 7.36，95%CI 1.01~53.55)。细菌学确诊的结核病在APHIV中的发病率为1.3/100Py，而在HIV阴性的青少年中为0.3/100Py，这表明尽管可以获得抗逆转录病毒治疗，APHIV患结核病的风险增加了四倍。此外，登记时QFT为阳性并不能预测这一人群中的结核病。结核病的高发病率发生在APHIV中，尽管艾滋病毒阴性青少年的QFT转换率相似。必须加强在这一弱势群体中预防结核病的战略。
There are limited data on Tuberculosis (TB) in adolescents with perinatally acquired HIV (APHIV). We examined the incidence and determinants of TB infection and disease in the Cape Town Adolescent Antiretroviral Cohort (CTAAC). Youth between nine and fourteen years on antiretroviral therapy (ART) for more than six months in public sector care, and age‐matched HIV‐negative adolescents, were enrolled between July 2013 through March 2015 and followed six‐monthly. Data were censored on 31 October 2018. Symptom screening, chest radiograph, viral load, CD4 count, QuantiFERON (QFT) and sputum for Xpert MTB/RIF, microscopy, culture and sensitivity were performed annually. TB infection was defined by a QFT of >0.35 IU/mL. TB diagnosis was defined as confirmed (culture or Xpert MTB/RIF positive) or unconfirmed (clinical diagnosis and started on TB treatment). Analyses examined the incidence and determinants of TB infection and disease. Overall 496 HIV+ and 103 HIV‐negative participants (median age at enrolment 12 years (interquartile range, IQR 10.6 to 13.3) were followed for a median of 3.1 years (IQR 3.0 to 3.4); 50% (298/599) were male. APHIV initiated ART at median age 4.4 years (IQR 2.1 to 7.6). At enrolment, 376/496 (76%) had HIV viral load <40 copies/mL, median CD4 count was 713 cells/mm3 and 179/559 (32%) were QFT+, with no difference by HIV status (APHIV 154/468, 33%; HIV negative 25/91, 27%; p = 0.31). The cumulative QFT+ prevalence was similar (APHIV 225/492, 46%; 95%CI 41% to 50%; HIV negative 44/98, 45%; 95% CI 35% to 55%; p = 0.88). APHIV had a higher incidence of all TB disease than HIV‐negative adolescents (2.2/100PY, 95% CI 1.6 to 3.1 vs. 0.3/100PY, 95% CI 0.04 to 2.2; IRR 7.36, 95% CI 1.01 to 53.55). The rate of bacteriologically confirmed TB in APHIV was 1.3/100 PY compared to 0.3/100PY for HIV‐negative adolescents, suggesting a fourfold increased risk of developing TB disease in APHIV despite access to ART. In addition, a positive QFT at enrolment was not predictive of TB in this population. High incidence rates of TB disease occur in APHIV despite similar QFT conversion rates to HIV‐negative adolescents. Strategies to prevent TB in this vulnerable group must be strengthened.
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影响因子：
3.7
作者：
Mahomed H;Hawkridge T;Verver S;Abrahams D;Geiter L;Hatherill M;Ehrlich R;Hanekom WA;Hussey GD
通讯作者：
Hussey GD
影响因子：
3.7
作者：
Bygrave H;Mtangirwa J;Ncube K;Ford N;Kranzer K;Munyaradzi D
通讯作者：
Munyaradzi D
影响因子：
4.4
作者：
Brittain K;Asafu-Agyei NA;Hoare J;Bekker LG;Rabie H;Nuttall J;Roux P;Stein DJ;Zar HJ;Myer L
通讯作者：
Myer L
影响因子：
5
作者：
Dodd PJ;Looker C;Plumb ID;Bond V;Schaap A;Shanaube K;Muyoyeta M;Vynnycky E;Godfrey-Faussett P;Corbett EL;Beyers N;Ayles H;White RG
通讯作者：
White RG
影响因子：
15.8
作者：
Ferrand, Rashida A.;Bandason, Tsitsi;Corbett, Elizabeth L.
通讯作者：
Corbett, Elizabeth L.