HIV infection and silicosis: the impact of two potent risk factors on the incidence of mycobacterial disease in South African miners
HIV infection and silicosis: the impact of two potent risk factors on the incidence of mycobacterial disease in South African miners
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DOI：
10.1097/00002030-200012010-00016
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发表时间：
2000-12-01
期刊：
影响因子：
3.8
通讯作者：
De Cock, KM
中科院分区：
文献类型：
--
作者：
Corbett, EL;Churchyard, GJ;De Cock, KM
目的：为了调查HIV感染和矽肺对分枝杆菌病的联合作用设计和设置：一个回顾性队列，1374名HIV阳性和2648名HIV阴性矿工参加了南非金矿医院和初级卫生诊所。参与者：1991-1996年期间在初级保健诊所经同意接受艾滋病毒检测的矿工，结果：HIV阳性和HIV阴性矿工结核病发病率分别为4.9/100人年和1.1/100人年。堪萨斯分枝杆菌病的发病率也很高（分别为0.32和0.10/100人-年）。矽肺是非常普遍的，这意味着不充分的粉尘控制，是一个显着的结核病的危险因素，艾滋病毒阳性和阴性的男性（调整后的发病率比1.4-2.5，根据放射严重性）。这些数据与矽肺和艾滋病病毒结合的风险相乘一致，但不符合相加模型。在研究期间，HIV阳性矽肺患者中HIV相关结核病的发病率显著增加，HIV阴性率没有相应变化，达到16.1/100人年。矽肺病和艾滋病毒感染的风险联合收割机成倍增加，因此结核病在艾滋病毒阳性矿工和艾滋病毒阴性矿工中仍然是一种与矽肺病有关的职业病，艾滋病毒阳性的矽肺患者的结核病发病率比其他艾滋病毒阳性的非洲人高得多。随着时间的推移，艾滋病毒的影响越来越大，这可能表明流行性结核病的传播与艾滋病毒感染的矿工疾病的快速发展。类似的但目前未被认识到的相互作用可能会导致其他受艾滋病毒流行影响的工业化国家的结核病控制问题。(C)2000年利平科特威廉姆斯&威尔金斯。
Objective: To investigate the combined effects of HIV infection and silicosis on mycobacterial diseaseDesign and setting: A retrospective cohort of 1374 HIV-positive and 2648 HIV-negative miners who attended a South African gold mining hospital and primary health clinics.Participants: Miners who had been tested for HIV, with consent, at primary health clinics during 1991-1996, predominantly because of a symptomatic sexually transmitted disease.Results: Tuberculosis (TB) incidence was 4.9 and 1.1 per 100 person-years in HIV-positive and HIV-negative miners respectively. The incidence of Mycobacterium kansasii disease was also high (0.32 and 0.10 per 100 person-years, respectively). Silicosis was highly prevalent, implying inadequate dust control, and was a significant TB risk factor among both HIV-positive and HIV-negative men (adjusted incidence rate ratios 1.4-2.5 according to radiological severity). The data were consistent with the risks of silicosis and HIV combining multiplicatively, but did not fit an additive model. The incidence of HIV-associated TB increased significantly during the study, with no corresponding change in HIV-negative rates, to reach 16.1 per 100 person-years among HIV-positive silicotics.Conclusions: The risks of silicosis and HIV infection combine multiplicatively, so that TB remains as much a silica-related occupational disease in HIV-positive as in HIV-negative miners, and HIV-positive silicotics have considerably higher TB incidence rates than those reported from other HIV-positive Africans. The increasing impact of HIV over time may indicate epidemic TB transmission with rapid disease development in HIV-infected miners. Similar but currently unrecognized interactions may be contributing to TB control problems in other industrializing countries affected by the HIV epidemic. (C) 2000 Lippincott Williams & Wilkins.