The impact of HIV and ART on recurrent tuberculosis in a sub-Saharan setting
The impact of HIV and ART on recurrent tuberculosis in a sub-Saharan setting
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DOI：
10.1097/qad.0b013e32835958ed
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发表时间：
2012-11-13
期刊：
影响因子：
3.8
通讯作者：
Crampin, Amelia C.
中科院分区：
文献类型：
--
作者：
Houben, Rein M. G. J.;Glynn, Judith R.;Crampin, Amelia C.
目的：评估抗逆转录病毒治疗（ART）对非洲人群复发性结核病（TB）发病率的影响。设计图：一个长期的人口队列在Karonga区，北方Malawi.Methods：自1996年以来，已完成实验室确诊的结核病治疗的患者每年进行访问，以记录生命状态，抗逆转录病毒疗法的使用和结核病筛查。生存分析估计了治疗完成时HIV/ART状态对死亡率和复发的影响。分析分层的时间，因为治疗完成估计复发（主要是在第一年）和再感染疾病（主要是以后）的影响。结果：在1133指数结核病例贡献4353人年的后续行动，有307人死亡，103实验室确认复发（复发率4.6每100人年）。一半的复发发生在完成治疗后的第一年。HIV感染增加了复发率[经年龄、性别、时期和TB类型校正的率比为2.69，95%置信区间（CI）为1.69-4.26]，但第一年的影响（校正率比为1.71，95% CI为0.87-3.35）小于随后的影响（校正率比为4.2，95% CI为2.16-8.15）。接受抗逆转录病毒治疗的患者的复发率介于HIV阴性患者和HIV阳性患者之间，与HIV阳性患者相比，调整后的复发率比值为0.74（95% CI 0.27-2.06），第一年为0.43（95% CI 0.11-1.73）。在HIV阳性患者中观察到的结核病复发率增加似乎被ART降低。因此，抗逆转录病毒疗法对减少复发的影响在结核病高发环境中最大。(C)2012威科健康垂直酒吧Lippincott威廉姆斯& Wilkins
Objective: To estimate the impact of antiretroviral therapy (ART) on the incidence of recurrent tuberculosis (TB) in an African population. Design: A long-term population cohort in Karonga District, northern Malawi.Methods: Patients who had completed treatment for laboratory-confirmed TB diagnosed since 1996 were visited annually to record vital status, ART use and screen for TB. Survival analysis estimated the effect of HIV/ART status at completion of treatment on mortality and recurrence. Analyses were stratified by time since treatment completion to estimate the effects on relapse (predominates during first year) and reinfection disease (predominates later).Results: Among 1133 index TB cases contributing 4353 person-years of follow-up, there were 307 deaths and 103 laboratory-confirmed recurrences (recurrence rate 4.6 per 100 person-years). Half the recurrences occurred in the first year since completing treatment. HIV infection increased the recurrence rate [rate ratio adjusted for age, sex, period and TB type 2.69, 95% confidence interval (CI) 1.69-4.26], but with less effect in the first year (adjusted rate ratio 1.71, 95% CI 0.87-3.35) than subsequently (adjusted rate ratio 4.2, 95% CI 2.16-8.15). Recurrence rates on ART were intermediate between those of HIV-negative individuals and HIV-positive individuals without ART. Compared with HIV-positive individuals without ART, the adjusted rate ratio was 0.74 (95% CI 0.27-2.06) in the first year, and 0.43 (95% CI 0.11-1.73) later.Conclusion: The increased incidence of TB recurrence observed in HIV-positive patients appeared to be reduced by ART. The effects are mostly on later (likely reinfection) disease so the impact of ART on reducing recurrence will be highest in high TB incidence settings. (C) 2012 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins