Anti-retroviral therapy reduces incident tuberculosis in HIV-infected children
Anti-retroviral therapy reduces incident tuberculosis in HIV-infected children
复制标题
DOI：
10.1093/ije/dyp208
复制
发表时间：
2009-12-01
影响因子：
7.7
通讯作者：
Behets, Frieda
中科院分区：
文献类型：
--
作者：
Edmonds, Andrew;Lusiama, Jean;Behets, Frieda
方法我们分析了2004年12月至2008年4月在刚果金沙萨参加艾滋病护理项目的未接受过抗逆转录病毒治疗的无结核病儿童的数据。为了估计ART对结核病发病率的影响，同时占暴露的时间依赖性混杂因素，一个考克斯比例风险边际结构models.Results 364名儿童贡献了596.0人年的后续行动。基线时，中位年龄为6.9岁; 163例（44.8%）处于HIV临床3期或4期。在随访期间，242名（66.5%）儿童开始接受抗逆转录病毒治疗，81名（22.3%）儿童发展为结核病。在结核病诊断时，41人（50.6%）正在接受抗逆转录病毒治疗。接受抗逆转录病毒治疗的患者的结核病发病率为10.2/100人-年[95%置信区间（CI）7.4-13.9]，而仅接受初级艾滋病毒治疗的患者为20.4/100人-年（95% CI 14.6-27.8）。结核病发病率随着抗逆转录病毒治疗时间的延长而下降，从治疗前6个月的18.9/100人-年下降到治疗12个月后的5.3/100人-年。模型估计抗逆转录病毒治疗的结核病风险比为0.51（95%CI 0.27-0.94）。
Methods We analysed data from ART-naive, TB disease-free children enrolled between December 2004 and April 2008 into an HIV care program in Kinshasa, Democratic Republic of Congo. To estimate the effect of ART on TB incidence while accounting for time-dependent confounders affected by exposure, a Cox proportional hazards marginal structural model was used.Results 364 children contributed 596.0 person-years of follow-up. At baseline, the median age was 6.9 years; 163 (44.8%) were in HIV clinical stage 3 or 4. During follow-up, 242 (66.5%) children initiated ART and 81 (22.3%) developed TB. At TB diagnosis, 41 (50.6%) were receiving ART. The TB incidence rate in those receiving ART was 10.2 per 100 person-years [95% confidence interval (CI) 7.4-13.9] compared with 20.4 per 100 person-years (95% CI 14.6-27.8) in those receiving only primary HIV care. TB incidence decreased with time on ART, from 18.9 per 100 person-years in the first 6 months to 5.3 per 100 person-years after 12 months of ART. The model-estimated TB hazard ratio for ART was 0.51 (95% CI 0.27-0.94).Conclusions For HIV-infected children in TB-endemic areas, ART reduces the hazard of developing TB by 50%.