Use of a WHO-recommended algorithm to reduce mortality in seriously ill patients with HIV infection and smear-negative pulmonary tuberculosis in South Africa: an observational cohort study
Use of a WHO-recommended algorithm to reduce mortality in seriously ill patients with HIV infection and smear-negative pulmonary tuberculosis in South Africa: an observational cohort study
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DOI：
10.1016/s1473-3099(11)70057-3
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发表时间：
2011-07-01
影响因子：
56.3
通讯作者：
Rustomjee, Roxana
中科院分区：
文献类型：
--
作者：
Holtz, Timothy H.;Kabera, Gaetan;Rustomjee, Roxana
背景2007年，世卫组织发布了关于诊断和治疗艾滋病毒/艾滋病重症患者涂阴肺结核的修订建议和算法。我们的目的是评估这些建议对南非患者临床结果的影响。方法我们从夸祖鲁省的三家医院招募了患有艾滋病毒感染和疑似涂片阴性肺结核的重病患者（年龄>= 15岁）。纳塔尔，南非。患者连续入组两个队列：第一个队列根据标准实践管理，第二个队列根据WHO推荐的算法管理。主要终点是率继续住院7天后入院和生存8周后accounting.Findings 338例患者参加了标准实践之间的队列，2008年8月，2009年2月，187年3月，2009年12月，2009年3月和12月之间的算法队列。入院后7天，算法队列中27%（n=50）的患者仍在住院，而标准实践队列中为38%（n=130）（率比0.70，95% CI 0.53-0.91; p=0.009）。入院后8周，算法队列中83%（n=156）的患者存活，而标准实践队列中为68%（n=230）（1.23，1.11-1.35; p=0.0001），并根据医院所在地进行了修改。解释在HIV感染和疑似涂阴肺结核的重症患者中，按照世界卫生组织的标准及早进行抗结核治疗，可以大大降低南非的死亡率。
Background In 2007, WHO released revised recommendations and an algorithm for the diagnosis and treatment of smear-negative pulmonary tuberculosis in seriously ill people living with HIV/AIDS. We aimed to assess the effect of the recommendations on clinical outcome in patients in South Africa.Methods We enrolled seriously ill patients (aged >= 15 years) with HIV infection and suspected smear-negative pulmonary tuberculosis from three hospitals in KwaZulu.Natal, South Africa. Patients were consecutively enrolled into two cohorts: the first cohort was managed according to standard practice, and the second according to the WHO-recommended algorithm. The primary endpoints were rates of continued stay in hospital at 7 days after admission and survival at 8 weeks after admission.Findings 338 patients were enrolled in the standard practice cohort between August, 2008, and February, 2009, and 187 were enrolled in the algorithm cohort between March, 2009, and December, 2009. 7 days after hospital admission, 27% (n=50) of patients in the algorithm cohort were still in hospital, compared with 38% (n=130) in the standard practice cohort (rate ratio 0.70, 95% CI 0.53-0.91; p=0.009). 8 weeks after admission, 83% (n=156) of patients in the algorithm cohort were alive, compared with 68% (n=230) in the standard practice cohort (1.23, 1.11-1.35; p=0.0001), with effect modified by hospital location.Interpretation In seriously ill patients with HIV infection and suspected smear-negative pulmonary tuberculosis, early antituberculosis treatment according to the WHO algorithm could significantly reduce mortality in South Africa.