An epidemiological study of tuberculosis and HIV infection in Tanzania, 1991-1993
An epidemiological study of tuberculosis and HIV infection in Tanzania, 1991-1993
复制标题
DOI：
10.1097/00002030-199603000-00009
复制
发表时间：
1996-03-01
期刊：
影响因子：
3.8
通讯作者：
Rieder, HL
中科院分区：
文献类型：
--
作者：
Chum, HJ;OBrien, RJ;Rieder, HL
目的：在过去 6 年中，坦桑尼亚报告的结核病 (TB) 病例几乎增加了一倍，与涂片阳性病例相比，涂片阴性和肺外病例的增幅要大得多。与此同时，艾滋病毒感染已在全国范围内广泛传播。进行这项调查的目的是研究结核病和艾滋病毒的关联，并确定艾滋病毒对坦桑尼亚当前和未来结核病病例的影响。 方法：调查设计对全国范围内具有代表性的样本进行艾滋病毒检测，该样本占 1991 年 1 月至 1993 年 12 月期间登记的所有新发病例和复发病例的大约六分之一，并与这些病例的人口、临床和细菌学数据相联系。艾滋病毒监测数据用于比较。结果：全国20个大陆地区共检测了6928例结核病病例。总体 HIV 血清阳性率为 32%。女性、25-44 岁人群、城市居民、涂片阴性和肺外疾病病例以及有卡介苗 (BCC) 疫苗接种疤痕的人群中，HIV 感染的粗略比值比 (OR) 和调整后比值比 (OR) 均较高；与同一地区的献血者相比，经年龄和性别调整后的结核病患者感染 HIV 的相对风险为 7.1（95% 置信区间为 6.6-7.5），并且在 25-34 岁人群中显着更高。在 3360 名患者的细菌培养结果中，46% 的结核分枝杆菌培养呈阳性。对1164株菌株进行药敏试验，总体耐药率为6.2%。 HIV 阳性 (4%) 和 HIV 阴性 (5.8%) 患者的初始耐药率都很低。获得性耐药率较高（总体为 19%），并且不会因 HIV 血清状态而发生显着变化。最初对异烟肼和利福平的联合耐药性并不常见（0.4%），对利福平的单耐药性（0.3%）也不常见。结论：女性和年轻人的 OR 较高反映了这些人群中 HIV 感染率较高。涂阳复发病例与新涂阳病例相比，感染艾滋病毒的可能性并不高，这一发现表明，新病例的治疗方案对艾滋病毒相关结核病有效。 HIV阳性患者的初始耐药率和获得性耐药率均较低，这进一步证明了治疗的充分性。 25-34 岁患者感染 HIV 的相对风险较高，表明与 HIV 相关的结核病传播增加。最后，据估计，该国涂阳结核病发病率增加的大约三分之二可直接归因于艾滋病毒感染。
Objective: In Tanzania during the past 6 years reported tuberculosis (TB) cases have nearly doubled, with proportionately much greater increases in smear-negative and extrapulmonary cases compared with smear-positive cases. At the same time, HIV infection has become widespread throughout the country. This survey was undertaken in order to study the association of TB and HIV and to determine the impact of HIV on present and future TB cases in Tanzania.Methods: The survey design provided for HIV testing of a representative country-wide sample of approximately one-sixth of all new and relapse cases registered between January 1991 and December 1993, with linkage to demographic, clinical and bacteriological data for these cases. HIV surveillance data were used for comparison purposes.Results: A total of 6928 TB cases from all of the country's 20 mainland regions were tested. The overall HIV seroprevalence was 32%. Both crude and adjusted odds ratios (OR) for HIV infection were higher in women, those aged 25-44 years, urban residents, cases of smear-negative and extrapulmonary disease, and persons with a bacille Calmette-Guerin (BCC) vaccination scar; The age-and sex-adjusted relative risk for HIV infection in TB patients compared to blood donors in the same regions was 7.1 (95% confidence interval, 6.6-7.5), and was significantly higher among those aged 25-34 years. Of 3360 patients with bacteriological culture results 46% were culture-positive for Mycobacterium tuberculosis. Drug susceptibility tests were performed on 1164 isolates with the overall rate of drug resistance of 6.2%. Rates of initial resistance were low in both HIV-positive (4%) and HIV-negative (5.8%) patients. Rates of acquired resistance were higher (19% overall) and did not vary significantly by HIV serostatus. Initial combined resistance to both isoniazid and rifampicin was uncommon (0.4%) as was monoresistance to rifampicin (0.3%).Conclusions: The higher OR for women and young adults reflect the higher rates of HIV infection in those populations. The finding that smear-positive relapse cases were no more likely to have HIV infection than new smear-positive cases suggests that the treatment regimen for new cases is effective in HIV-associated TB. The low rates of both initial and acquired drug resistance in HIV-positive patients is further evidence of adequacy of treatment. The higher relative risk for HIV infection among patients aged 25-34 years suggests increased HIV-related TB transmission. Finally, it is estimated that approximately two-thirds of the increase in the rate of smear-positive tuberculosis in the country can be directly attributed to HIV infection.