Human immunodeficiency virus and the prevalence of undiagnosed tuberculosis in African gold miners
Human immunodeficiency virus and the prevalence of undiagnosed tuberculosis in African gold miners
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DOI：
10.1164/rccm.200405-590oc
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发表时间：
2004-09-15
影响因子：
24.7
通讯作者：
Churchyard, GJ
中科院分区：
文献类型：
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作者：
Corbett, EL;Charalambous, S;Churchyard, GJ
我们假设，快速呈现可能是结核病（TB）与人类免疫缺陷病毒（HIV）相关的一般特征，限制了HIV对结核病流行的影响。为了调查这一点，我们进行了一项横断面艾滋病毒和结核病调查，并进行了回顾性和前瞻性随访。在1 773名系统招募的矿工中，艾滋病毒感染率为27%。与未确诊的结核病的点患病率（优势比，1.7; 95%CI，0.9-3.3）相比，结核病的发病率与艾滋病毒的相关性更强（发病率比，5.5; 95%CI，3.5-8.6）。对于痰检阳性结核病，9例流行病例中有7例（78%）为HIV阴性，HIV阳性矿工的点患病率无显著性降低（比值比，0.8; 95%CI，0.1-4.2）。计算出的诊断前涂片阳性的平均持续时间（点患病率/发病率），HIV阳性结核病患者明显短于HIV阴性结核病患者（分别为0.17年和1.15年;比值为0.15; 95%CI为0.00-0.73）。艾滋病毒对结核病点流行率的影响远小于对结核病发病率的影响，这可能是因为疾病的快速进展增加了发病率和病例发现率。涂片阳性平均持续时间的差异特别显著，如果可以推广，将对艾滋病毒高流行地区的结核病控制前景产生重大影响。
We hypothesized that rapid presentation may be a general feature of tuberculosis (TB) associated with human immunodeficiency virus (HIV) that limits the impact of HIV on the point prevalence of TB. To investigate this, we performed a cross-sectional HIV and TB disease survey with retrospective and prospective follow-up. HIV prevalence among 1,773 systematically recruited miners was 27%. TB incidence was much more strongly HIV associated (incidence rate ratio, 5.5; 95% confidence interval [CI], 3.5-8.6) than the point prevalence of undiagnosed TB disease (odds ratio, 1.7; 95% CI, 0.9-3.3). For smear-positive TB, 7 of 9 (78%) prevalent cases were HIV negative, and point prevalence was nonsignificantly lower in miners who were HIV positive (odds ratio, 0.8; 95% CI, 0.1-4.2). The calculated mean duration of smear positivity before diagnosis (point prevalence/incidence) was substantially shorter for HIV-positive than HIV-negative TB patients (0.17 and 1.15 years, respectively; ratio, 0.15; 95% CI, 0.00-0.73). HIV has considerably less impact on the point prevalence of TB disease than on TB incidence, probably because rapid disease progression increases presentation and case-finding rates. The difference in mean duration of smear positivity was particularly marked and, if generalizable, will have major implications for TB control prospects in high HIV prevalence areas.