High prevalence of subclinical tuberculosis in HIV-1-infected persons without advanced immunodeficiency: implications for TB screening.
High prevalence of subclinical tuberculosis in HIV-1-infected persons without advanced immunodeficiency: implications for TB screening.
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DOI：
10.1136/thx.2011.160168
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发表时间：
2011-08
期刊：
影响因子：
10
通讯作者：
Wilkinson RJ
中科院分区：
文献类型：
--
作者：
Oni T;Burke R;Tsekela R;Bangani N;Seldon R;Gideon HP;Wood K;Wilkinson KA;Ottenhoff TH;Wilkinson RJ
最近诊断的HIV-1感染者在接受抗逆转录病毒治疗前门诊就诊的无症状结核病患病率没有得到很好的描述。此外，尚不清楚这些患者中结核分枝杆菌的检测是否明确表示早期无症状阶段，导致疾病进展或杆菌的短暂排泄。描述不适合接受抗逆转录病毒治疗的HIV-1感染者中亚临床结核病的患病率和结局。该研究在南非开普敦Khayelitsha日间医院的274名无症状抗逆转录病毒治疗初治HIV-1感染者中进行。所有参与者都使用症状筛查进行了结核病筛查，并进行了间隔寡聚分型以确定基因型。亚临床TB疾病的患病率为8.5%（95% CI 5.1%至13.0%）（n=18;培养阳性的中位天数为17天），22%的患者为涂片阳性。 Spoligotyping显示了多种多样的基因型，所有配对的分离株都是相同的spoligotype，有效地排除了交叉污染。56%的患者在3天至2个月后出现症状。 所有人都很好，在结核病诊断后6-12个月仍在护理中 ;结核菌素皮肤试验阳性（OR 4.96，p=0.064）、低CD 4计数（OR 0.996，p=0.06）和自HIV诊断以来的年数（OR 1.006，p=0.056）显示了预测TB疾病的趋势。这项研究发现，HIV-1感染者中亚临床结核病的患病率很高，但结局良好（保持护理）。结果表明，在高艾滋病毒/结核病流行的环境中，阳性的HIV-1检测应提示结核病筛查痰培养，无论症状如何，特别是在结核菌素皮肤试验阳性，HIV感染史较长和低CD 4计数。在资源有限的情况下，结核病培养筛查的操作困难突出表明，需要快速和负担得起的护理点检测，以确定患有临床和亚临床结核病的人。
The prevalence of asymptomatic tuberculosis (TB) in recently diagnosed HIV-1-infected persons attending pre-antiretroviral therapy (ART) clinics is not well described. In addition, it is unclear if the detection of Mycobacterium tuberculosis in these patients clearly represents an early asymptomatic phase leading to progressive disease or transient excretion of bacilli. To describe the prevalence and outcome of subclinical TB disease in HIV-1-infected persons not eligible for ART. The study was conducted in 274 asymptomatic ART-naïve HIV-1-infected persons in Khayelitsha Day Hospital, Cape Town, South Africa. All participants were screened for TB using a symptom screen and spoligotyping was performed to determine genotypes. The prevalence of subclinical TB disease was 8.5% (95% CI 5.1% to 13.0%) (n=18; median days to culture positivity 17 days), with 22% of patients being smear-positive. Spoligotyping showed a diverse variety of genotypes with all paired isolates being of the same spoligotype, effectively excluding cross-contamination. 56% of patients followed up developed symptoms 3 days to 2 months later. All were well and still in care 6–12 months after TB diagnosis; 60% were started on ART. A positive tuberculin skin test (OR 4.96, p=0.064), low CD4 count (OR 0.996, p=0.06) and number of years since HIV diagnosis (OR 1.006, p=0.056) showed trends towards predicting TB disease. This study found a high prevalence but good outcome (retained in care) of subclinical TB disease in HIV-1-infected persons. The results suggest that, in high HIV/TB endemic settings, a positive HIV-1 test should prompt TB screening by sputum culture irrespective of symptoms, particularly in those with a positive tuberculin skin test, longer history of HIV infection and low CD4 count. Operational difficulties in resource-constrained settings with respect to screening with TB culture highlight the need for rapid and affordable point-of-care tests to identify persons with clinical and subclinical TB disease.
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影响因子：
15.8
作者：
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