Impact of pulmonary tuberculosis on survival of HIV-infected adults: a prospective epidemiologic study in Uganda
Impact of pulmonary tuberculosis on survival of HIV-infected adults: a prospective epidemiologic study in Uganda
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DOI：
10.1097/00002030-200006160-00020
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发表时间：
2000-06-16
期刊：
影响因子：
3.8
通讯作者：
Ellner, JJ
中科院分区：
文献类型：
--
作者：
Whalen, CC;Nsubuga, P;Ellner, JJ
背景：对结核病的回顾性队列研究表明，活动性结核病加速了HIV感染的进展。这些发现的有效性受到了质疑，因为他们的回溯性设计，研究人群的多样性，抗结核治疗的不同依从性以及抗逆转录病毒药物的使用。为了评估结核病对HIV感染患者生存的影响，我们在患有和不患有结核病的乌干达HIV感染者中进行了一项前瞻性研究。方法：在前瞻性队列研究中，230名HIV相关结核病患者和442名HIV感染者非结核病患者接受了平均19个月的生存跟踪调查。结果：230例肺结核患者中63例死亡(28%)，442例对照组中85例死亡(19%)，风险比为1.4[95%可信区间(CI)，1.07~1.87]。大多数死亡发生在基线时CD_4淋巴细胞计数<200×10~(6)细胞/L的患者(n=99)，在肺结核患者(46%)和对照组(44%)中发生的频率相似。然而，当CD_4淋巴细胞计数为200×10(6)/L时，与非结核病患者相比，HIV相关结核病患者死亡的相对风险是2.1(195%可信区间，1.27~3.62)。在CD_4淋巴细胞计数为200×10(6)/L的患者中，病例组的1年生存率略低于对照组(0.91比0.96)，但两年后病例组的生存率显著低于对照组(0.84比0.91；P200×10(6)/L和1.50(95%CI，0.99~2.40)。结论：活动性肺结核在HIV感染的早期阶段对存活率的影响最大，此时存在宿主免疫应答的储备能力。这些观察结果为HIV感染者潜在结核感染的治疗提供了理论依据。(C)2000年Lippincott Williams&Wilkins。
Background: Retrospective cohort studies of tuberculosis suggest that active tuberculosis accelerates the progression of HIV infection. The validity of these findings has been questioned because of their retrospective design, -diverse study populations, variable compliance with anti-tuberculous therapy and use of anti-retroviral medication. To assess the impact of tuberculosis on survival in HIV infection we performed a prospective study among HIV-infected Ugandan adults with and without tuberculosis.Methods: In a prospective cohort study, 230 patients with HIV-associated tuberculosis and 442 HIV-infected subjects without tuberculosis were followed for a mean duration of 19 months for survival. To assess changes in viral load over 1 year, 20 pairs of tuberculosis cases and controls were selected and matched according to baseline CD4 lymphocyte count, age, sex and tuberculin skin test status.Results: During the follow-up period, 63 out of of 230 tuberculosis cases (28%) died compared with 85 out of 442 controls (19%), with a crude risk ratio of 1.4 [95% confidence interval (CI), 1.07-1.87]. Most deaths occurred in patients with CD4 lymphocyte counts < 200 x 10(6) cells/l at baseline (n = 99) and occurred with similar frequency in the tuberculosis cases (46%) and the controls (44%). When the CD4 lymphocyte count was > 200 x 10(6) /l, however, the relative risk of death in HIV-associated tuberculosis was 2.1 (195% CI, 1.27-3.62) compared with subjects without tuberculosis. For subjects with a CD4 lymphocyte count > 200 X 10(6)/l, the 1-year survival proportion was slightly lower in the cases than in the controls (0.91 versus 0.96), but by 2 years the survival proportion was significantly lower in the cases than in the controls (0.84 versus 0.91; P 200 x 10(6)/l and 1.5 (95% CI, 0.99-2.40) for subjects with a CD4 lymphocyte count of 200 x 10(6)/l or fewer.Conclusion: The findings from this prospective study indicate that active tuberculosis exerts its greatest effect on survival in the early stages of HIV infection, when there is a reserve capacity of the host immune response. These observations provide a theoretical basis for the treatment of latent tuberculous infection in HIV-infected persons. (C) 2000 Lippincott Williams & Wilkins .