Undiagnosed tuberculosis in a community with high HIV prevalence - Implications for tuberculosis control
Undiagnosed tuberculosis in a community with high HIV prevalence - Implications for tuberculosis control
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DOI：
10.1164/rccm.200606-759oc
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发表时间：
2007-01-01
影响因子：
24.7
通讯作者：
Bekker, Linda-Gail
中科院分区：
文献类型：
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作者：
Wood, Robin;Middelkoop, Keren;Bekker, Linda-Gail
背景资料：虽然撒哈拉以南非洲结核病控制的失败是由于艾滋病毒的流行，但目前还不清楚为什么直接观察短期治疗（DOTS）战略在这种情况下是不够的。我们进行了一项横断面调查的肺结核（PTB）和艾滋病病毒感染的社区13,000高艾滋病病毒流行率和高结核病的通知率和运作良好的DOTS结核病控制programmes.Methods：积极的情况下发现的PTB进行了762例成人使用痰显微镜和结核分枝杆菌培养，检测艾滋病病毒，症状和危险因素问卷。调查结果与从TB治疗register.Results中提取的通知数据相关：在接受调查的人中，174人（23%）检测出HIV阳性，11人（7人HIV阳性）正在接受TB治疗，6人（5人HIV阳性）以前未诊断的涂阳PTB，6人（4人HIV阳性）涂阴/培养阳性PTB。症状不是PTB的有用筛查。在HIV阳性和HIV阴性人群中，涂阳肺结核报告患病率分别为1563/10万和352/10万，未确诊涂阳肺结核患病率分别为2837/10万和175/10万，病例发现率分别为37%和67%。HIV阳性和HIV阴性个体的估计传染性持续时间相似。然而，87%的总人年未确诊的涂阳结核病在社区中的HIV感染individual.Conclusions：PTB被确定在9%的HIV感染者，5%以前未被诊断。缺乏提示PTB的症状可能导致病例发现率低。以被动发现病例为基础的DOTS策略应辅以以HIV感染者为目标的主动发现病例。
Background: Although failure of tuberculosis (TB) control in sub-Saharan Africa is attributed to the HIV epidemic, it is unclear why the directly observed therapy short-course (DOTS) strategy is insufficient in this setting. We conducted a cross-sectional survey of pulmonary TB (PTB) and HIV infection in a community of 13,000 with high HIV prevalence and high TB notification rate and a well-functioning DOTS TB control program.Methods: Active case finding for PTB was performed in 762 adults using sputum microscopy and Mycobacterium tuberculosis culture, testing for HIV, and a symptom and risk factor questionnaire. Survey findings were correlated with notification data extracted from the TB treatment register.Results: Of those surveyed, 174 (23%) tested HIV positive, 11 (7 HIV positive) were receiving TB therapy, 6 (5 HIV positive) had previously undiagnosed smear-positive PTB, and 6 (4 HIV positive) had smear-negative/culture-positive PTB. Symptoms were not a useful screen for PTB. Among HIV-positive and -negative individuals, prevalence of notified smear-positive PTB was 1,563/100,000 and 352/100,000, undiagnosed smear-positive PTB prevalence was 2,837/100,000 and 175/100,000, and case-finding proportions were 37 and 67%, respectively. Estimated duration of infectiousness was similar for HIV-positive and HIV-negative individuals. However, 87% of total person-years of undiagnosed smear-positive TB in the community were among HIV-infected individuals.Conclusions: PTB was identified in 9% of HIV-infected individuals, with 5% being previously undiagnosed. Lack of symptoms suggestive of PTB may contribute to low case-finding rates. DOTS strategy based on passive case finding should be supplemented by active case finding targeting HIV-infected individuals.