Effects of duration of HIV infection and secondary tuberculosis transmission on tuberculosis incidence in the South African gold mines
Effects of duration of HIV infection and secondary tuberculosis transmission on tuberculosis incidence in the South African gold mines
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DOI：
10.1097/qad.0b013e3283097cfa
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发表时间：
2008-09-12
期刊：
影响因子：
3.8
通讯作者：
Sonnenberg, Pam
中科院分区：
文献类型：
--
作者：
Glynn, Judith R.;Murray, Jill;Sonnenberg, Pam
背景资料：艾滋病毒通过免疫抑制直接增加了结核病的风险，并通过增加的病例数进一步传播结核分枝杆菌间接增加了结核病的风险。我们评估了自艾滋病毒血清转化以来这两种机制的贡献。方法：在对南非金矿工人进行的14年回顾性队列研究中估计了新肺结核的发病率。在1992-1993年的随机调查中以及在诊所中进行了艾滋病毒检测。确定了1950名血清转换间隔时间少于3年的HIV阳性男性，并与医疗、人口统计学和职业记录相关联。在一项调查中，他们与艾滋病毒阴性的男性进行了比较，后来没有艾滋病毒的证据。当男性被诊断为肺结核，死亡或离开mine.Results：结核病发病率上升后不久，艾滋病毒感染，达到1.4/100人年（95%置信区间1.1-1.9）在2年内，10.0/100人年（95%置信区间6.5-15.5）在10年或更长时间。到血清转换后11年，近一半的男性患有结核病。在5702名HIV阴性男性中，1991-1993年结核病发病率为0.48/100人-年（95%置信区间0.33-0.70），在研究期间（调整年龄后）翻了一番。调整后的模型估计表明，一半的结核病发病率增加的时间，因为艾滋病毒感染是由于增加发病率在日历period -的间接effect.Conclusion：第一次，我们已经表明，结核病的风险增加的时间，因为血清转换反映了艾滋病毒增加易感性的直接影响，和间接影响，由于向前传播。需要采取创新和持续的公共卫生措施来减少结核分枝杆菌的传播。(C)2008年威科健康垂直酒吧利平科特威廉姆斯&威尔金斯。
Background: HIV increases the risk of tuberculosis directly, through immunosuppression, and indirectly, through onward transmission of Mycobacterium tuberculosis from the increased caseload. We assess the contribution of these two mechanisms by time since seroconversion to HIV.Methods: The incidence of new pulmonary tuberculosis was estimated in a retrospective cohort study of South African gold miners over 14 years. HIV tests were done in random surveys in 1992-1993, and in clinics. One thousand nine hundred fifty HIV-positive men with seroconversion intervals of less than 3 years were identified and linked to medical, demographic and Occupational records. They were compared with men who were HIV-negative in a survey, with no later evidence of HIV. Analyses were censored when men were diagnosed with tuberculosis, died or left the mine.Results: Tuberculosis incidence rose soon after HIV infection, reaching 1.4/100 person-years(95% confidence interval 1.1-1.9)within 2 years, and 10.0/100 person-years (95% confidence interval 6.5-15.5) at 10 or more years. By 11 years from seroconversion, nearly half the men had had tuberculosis. Among 5702 HIV-negative men, tuberculosis incidence was 0.48/100 person-years (95% confidence interval 0.33-0.70) in 1991-1993 and doubled over the period of the study (after adjusting for age). Age-adjusted model estimates suggest that half the increase in tuberculosis incidence by time since HIV infection was attributable to increasing incidence over calendar period - the indirect effect.Conclusion: For the first time, we have shown that the increase in tuberculosis risk by time since seroconversion reflects both direct effects of HIV increasing Susceptibility, and indirect effects due to onward transmission. Innovative and sustained public health measures are needed to reduce Mycobacterium tuberculosis transmission. (C) 2008 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.