Trends in tuberculosis and the influence of HIV infection in northern Malawi, 1988-2001
Trends in tuberculosis and the influence of HIV infection in northern Malawi, 1988-2001
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DOI：
10.1097/01.aids.0000131336.15301.06
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发表时间：
2004-07-02
期刊：
影响因子：
3.8
通讯作者：
Fine, PEM
中科院分区：
文献类型：
--
作者：
Glynn, JR;Crampin, AC;Fine, PEM
目的：记录结核病（TB）在非洲农村的发病率和模式的变化和程度，他们受到艾滋病病毒的影响。方法：作为长期流行病学研究的一部分，在卡隆加区，马拉维，结核病和艾滋病病毒的病例对照研究进行了一系列从1988年起。这些研究的数据，从总人口调查，并从马拉维全国人口普查已被用来重建在该地区的结核病流行的变化，从1988年至2001年，研究的作用HIV。结果：所有确诊的结核病，新的痰检阳性结核病的发病率，在成人增加到高峰在20世纪90年代末，但似乎已经下降。三分之二的病例现在是艾滋病毒阳性。发病率上升最多的是30-44岁年龄组，妇女的发病率上升尤其明显，导致男女结核病发病率之比从1.3下降到0.8。新发涂阳肺结核病例中HIV感染者的比例从1988-1990年的17%上升到2000-2001年的57%，但在没有HIV感染者的情况下，涂阳肺结核的估计发病率从0.78/1000下降到0.45/1000。相反，它已经上升，主要影响年轻人和妇女。有一些证据表明，与艾滋病毒相关的结核病流行可能已经过了高峰期。(C)2004年利平科夫特威廉姆斯威尔金斯。
Objective: To document the changing incidence and patterns of tuberculosis (TB) in rural Africa and the extent to-which they are influenced by HIV.Methods: As part of longstanding epidemiological studies in Karonga District, Malawi, a series of case control studies of TB and HIV were conducted from 1988 onwards. Data from these studies, from a total population survey, and from the Malawi national census have been used to reconstruct the changes in the TB epidemic in the area from 1988 to 2001, examining the role of HIV.Results: The incidence of all confirmed TB, and of new smear-positive TB, in adults increased to peak in the late 1990s but appears to have decreased since. Two-thirds of cases are now HIV positive. The rise in incidence was greatest in the 30-44-year-old age: group and was particularly marked for women, leading to a decrease in the male : female ratio for TB incidence from 1.3 to 0.8. The proportion of new smear-positive TB cases attributable to HIV increased from 17% in 1988-1990 to 57% in 2000-2001, but the estimated rate of smear-positive TB in the absence of HIV decreased from 0.78/1000 to 0.45/1000.Conclusions: Without HIV the incidence of smear-positive TB would have fallen in this population. Instead it has risen and is predominantly affecting young adults and women. There is some evidence that the HIV-associated TB epidemic may have passed its peak. (C) 2004 Lippincoft Williams Wilkins.