A prospective study of tuberculosis and human immunodeficiency virus infection: Clinical manifestations and factors associated with survival
A prospective study of tuberculosis and human immunodeficiency virus infection: Clinical manifestations and factors associated with survival
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DOI：
10.1093/clind/24.4.661
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发表时间：
1997-04-01
影响因子：
11.8
通讯作者：
Klein, RS
中科院分区：
文献类型：
--
作者：
Alpert, PL;Munsiff, SS;Klein, RS
我们前瞻性地研究了人类免疫缺陷病毒（HIV）感染对结核病的表现和转归的影响。共确定了216例结核病患者;其中162例（75%）进行了HIV抗体检测; 92例（57%）血清学阳性。艾滋病毒血清反应阳性的患者更有可能是男性和西班牙裔，并且无家可归或被监禁。这些患者中有81%的CD 4淋巴细胞计数小于或等于200/mm（3）。血清学阳性患者比血清学阴性患者更常患肺外结核（比值比[OR]，2.3; 95%可信区间[Cl]，1.2-4.8）。非HIV感染的肺结核患者的抗酸杆菌涂片阳性率（74.5%）高于HIV感染的患者（54.3%）[OR，2.46; 95%CI，1.01-6.02]--即使是那些有局灶性或空洞性疾病的患者。延迟开始治疗与住院死亡率相关：从入院到开始治疗的中位时间，存活患者为4天，死亡患者为15天（P = 0.02）。在初次住院期间未死亡的HIV感染者的中位生存期为22.7个月。与生存率降低独立相关的因素包括免疫缺陷的严重程度、未使用直接观察治疗、耐药结核分枝杆菌感染和注射药物使用史。
We prospectively studied the effect of human immunodeficiency virus (HIV) infection on the presentation and outcome of tuberculosis, A total of 216 patients with tuberculosis were identified; 162 (75%) of these patients were tested for antibodies to HIV; 92 (57%) were seropositive. The patients who were seropositive for HIV were more likely to be male and Hispanic and to have been homeless or incarcerated. Eighty-one percent of these patients had CD4 lymphocyte counts of less than or equal to 200/mm(3). The seropositive patients had extrapulmonary tuberculosis more often than did the seronegative patients (odds ratio [OR], 2.3; 95% confidence interval [Cl], 1.2-4.8). Smears for acid-fast bacilli were positive more often for non-HIV-infected patients with pulmonary tuberculosis (74.5%) than for HIV-infected patients (54.3%) [OR, 2.46; 95% Cl, 1.01-6.02]-even those with focal or cavitary disease. A delay in initiating therapy was associated with in-hospital mortality: the median time from admission to the start of treatment was 4 days for patients who survived and 15 days for those who died (P = .02). The median survival was 22.7 months for HIV-infected patients who did not die during the initial hospitalization. Factors independently associated with reduced rates of survival included the severity of immunodeficiency, nonuse of directly observed therapy, infection due to drug-resistant Mycobacterium tuberculosis, and a history of injection drug use.