Reduction of HIV-associated excess mortality by antiretroviral treatment among tuberculosis patients in Kenya
Reduction of HIV-associated excess mortality by antiretroviral treatment among tuberculosis patients in Kenya
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DOI：
10.1371/journal.pone.0188235
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发表时间：
2017-11-16
期刊：
影响因子：
3.7
通讯作者：
Borgdorff, Martien W.
中科院分区：
文献类型：
--
作者：
Onyango, Dickens O.;Yuen, Courtney M.;Borgdorff, Martien W.
背景结核病死亡率仍然是一个全球性的公共卫生挑战。结核病与人类免疫缺陷病毒（HIV）一起成为全球主要的传染性死亡原因。艾滋病毒是结核病相关发病率和死亡率的主要驱动因素，而结核病是艾滋病毒/艾滋病感染者死亡的主要原因。我们试图确定与艾滋病毒和抗逆转录病毒治疗对降低死亡率之间的结核病患者在Kenya.MethodsWe进行了回顾性分析，从2013年到2014年登记的患者的肯尼亚国家结核病规划数据的影响，以确定过多的死亡率。我们采用直接标准化方法获得结核病患者与普通人群的标准化死亡率。我们根据携带艾滋病毒的结核病患者与不携带艾滋病毒的结核病患者的标准化死亡率比，计算了艾滋病毒导致的结核病死亡的人口归因比例。我们使用考克斯比例风险回归评估mortality.ResultsOf 162，014例患者纳入分析的危险因素，6%死亡。结核病患者的死亡率是普通人群的10.6倍（95%CI：10.4-10.8）; 42%的死亡可归因于艾滋病毒感染。未接受抗逆转录病毒治疗的艾滋病毒感染者的死亡风险是未接受抗逆转录病毒治疗者的4倍以上（aHR = 4.2，95% CI 3.9-4.6）。相比之下，艾滋病毒感染者接受抗逆转录病毒治疗的死亡风险只有2.6倍（aHR = 2.6，95%CI 2.5-2.7）。艾滋病毒感染者的死亡率在那些没有接受抗逆转录病毒治疗的人中高于那些接受抗逆转录病毒治疗的人。艾滋病毒感染者早期开始抗逆转录病毒治疗（“检测和治疗”方法）应进一步减少结核病相关死亡。
BackgroundMortality from TB continues to be a global public health challenge. TB ranks alongside Human Immunodeficiency Virus (HIV) as the leading infectious causes of death globally. HIV is a major driver of TB related morbidity and mortality while TB is the leading cause of mortality among people living with HIV/AIDS. We sought to determine excess mortality associated with HIV and the effect of antiretroviral therapy on reducing mortality among tuberculosis patients in Kenya.MethodsWe conducted a retrospective analysis of Kenya national tuberculosis program data of patients enrolled from 2013 through 2014. We used direct standardization to obtain standardized mortality ratios for tuberculosis patients compared with the general population. We calculated the population attributable fraction of tuberculosis deaths due to HIV based on the standardized mortality ratio for deaths among TB patients with HIV compared to TB patients without HIV. We used Cox proportional hazards regression for assessing risk factors for mortality.ResultsOf 162,014 patients included in the analysis, 6% died. Mortality was 10.6 (95% CI: 10.4-10.8) times higher among TB patients than the general population; 42% of deaths were attributable to HIV infection. Patients with HIV who were not receiving ART had an over four-fold risk of death compared to patients without HIV (aHR = 4.2, 95% CI 3.9-4.6). In contrast, patients with HIV who were receiving ART had only 2.6 times the risk of death (aHR = 2.6, 95% CI 2.5-2.7).ConclusionHIV was a significant contributor to TB-associated deaths in Kenya. Mortality among HIV-infected individuals was higher among those not on ART than those on ART. Early initiation of ART among HIV infected people (a "test and treat" approach) should further reduce TB-associated deaths.