Recurrent tuberculosis in HIV-infected patients in Rio de Janeiro, Brazil
Recurrent tuberculosis in HIV-infected patients in Rio de Janeiro, Brazil
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DOI：
10.1097/qad.0b013e328311ac4e
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发表时间：
2008-11-30
期刊：
影响因子：
3.8
通讯作者：
Saraceni, Valeria
中科院分区：
文献类型：
--
作者：
Golub, Jonathan E.;Durovni, Betina;Saraceni, Valeria
背景/目的：外源性再感染可能增加HIV感染患者结核病复发的风险。我们测量的频率和确定的风险因素，结核病复发在一个队列的HIV感染patients in Rio de Janeiro，Brazil.Methods：数据提取自1998年至2007年参加29个艾滋病诊所的HIV感染患者的医疗记录。分析的患者是那些没有结核病史之前，他们的第一次艾滋病毒门诊访问，谁有至少一个结核病发作后进入。发病率比风险组和考克斯比例风险回归模型之间的发病率进行比较，评估未经调整和调整association.Results：在1080艾滋病毒感染的结核病患者，96（8.9%）开发了复发诊断。诊断之间的中位时间为2.4年。与未复发患者相比，复发结核患者完成最初6个月结核治疗的患者较少（78%对86%; P = 0.02）。对于完成治疗的患者，复发发生率为2.5/100人-年，而未完成治疗的患者为9.0/100人-年（发生率比为3.60; 95%置信区间为1.92-6.32）。在多变量模型中，初始结核病治疗完成，接受抗逆转录病毒治疗，CD 4细胞计数超过200毫米（-3）的任何时间后，初步诊断与复发的风险显着降低。结论：结核病复发率高，在这个HIV感染人群。完成初始结核病治疗、使用抗逆转录病毒治疗和CD 4细胞计数增加与较低的复发率相关。使用二级预防治疗可能是必要的，以减少结核病的负担，艾滋病毒感染的患者。(C)2008年威科健康垂直酒吧Lippincott威廉姆斯&威尔金斯
Background/objective: The risk of recurrent tuberculosis may increase in HIV-infected patients due to exogenous reinfection. We measured the frequency of and determined risk factors for recurrent tuberculosis in a cohort of HIV-infected patients in Rio de Janeiro, Brazil.Methods: Data were abstracted from medical records of HIV-infected patients attending 29 HIV clinics between 1998 and 2007. Patients analyzed were those who had no tuberculosis history prior to their first HIV clinic visit and who had at least one episode of tuberculosis after entry. Incidence rate ratios compared incidence rates between risk groups and Cox proportional hazards regression models evaluated unadjusted and adjusted associations.Results: Among 1080 HIV-infected patients with tuberculosis, 96 (8.9%) developed a recurrent diagnosis. The median time between diagnoses was 2.4 years. Fewer patients with recurrent tuberculosis had completed their initial 6-month course of tuberculosis treatment compared with patients without recurrence (78 versus 86%; P = 0.02). For patients who completed therapy, the incidence rate of recurrence was 2.5/100 versus 9.0/100 person-years for noncompleters (incidence rate ratio, 3.60; 95% confidence interval, 1.92-6.32). In multivariate modeling, initial tuberculosis treatment completion, receipt of antiretroviral therapy, and CD4 cell count more than 200mm(-3) any time after the initial diagnosis were associated with a significantly decreased hazard of recurrence.Conclusion: Tuberculosis recurrence rates were high in this HIV-infected population. Completion of initial tuberculosis therapy, use of antiretroviral therapy, and increases in CD4 cell counts were associated with lower recurrence rates. Use of secondary preventive therapy might be warranted to reduce the burden of tuberculosis in patients with HIV infection. (C) 2008 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins