Human immunodeficiency virus and the outcome of treatment for new and recurrent pulmonary tuberculosis in African patients
Human immunodeficiency virus and the outcome of treatment for new and recurrent pulmonary tuberculosis in African patients
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DOI：
10.1164/ajrccm.159.3.9804147
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发表时间：
1999-03-01
影响因子：
24.7
通讯作者：
Godfrey-Faussett, P
中科院分区：
文献类型：
--
作者：
Murray, J;Sonnenberg, P;Godfrey-Faussett, P
本研究的目的是评估人类免疫缺陷病毒（HIV）感染对结核病（TB）治疗的影响。研究人群包括28，522名南非黑人金矿工人。1995年诊断为痰培养阳性的新发或复发性肺结核患者前瞻性入选该队列。在治疗开始后6个月进行直接观察治疗（DOT）和结局评估。结核病病例376例（发病率为每10万人1 318例），其中190例（50%）艾滋病毒呈阳性，82例（22%）结核病复发。HIV感染状况与既往结核病史或耐药性之间没有关联。无论是治疗中断率（2%）还是患者转出治疗计划的比率（1.6%）都与HIV状态无关。排除死亡，HIV阳性和HIV阴性患者的治愈率相似（89%对88%），但复发性结核病患者的治愈率明显低于新发结核病患者（77%对92%）。HIV阴性患者的死亡率为0.5%，HIV阳性患者的死亡率为13.7%，后者与CD4（+）淋巴细胞耗竭有关。尸检显示，在艾滋病毒阳性患者中，早期死亡是由于结核病，而晚期死亡最常见的是由于隐球菌肺炎。该研究表明，即使在结核病和艾滋病毒感染发病率很高的人群中，运行良好的结核病控制计划也可以达到可接受的治愈率。需要特别警惕并发感染，这可能会大大增加艾滋病毒阳性患者在结核病治疗期间的死亡率。
The purpose of this study was to evaluate the impact of human immunodeficiency virus (HIV) infection on treatment for tuberculosis (TB). The study population comprised 28,522 black Southern African gold miners. Patients with sputum culture-positive new or recurrent pulmonary TB diagnosed in 1995 were prospectively enrolled in the cohort. Directly observed therapy (DOT) was practiced and outcomes were assessed at 6 mo after treatment was begun. There were 376 cases of TB (incidence 1,318 per 100,000), of which 190 (50%) were HIV positive and 82 (22%) had recurrent TB. There was no association between HIV status and history of previous TB or drug resistance. Neither the treatment interruption rate (2%) nor the rate at which patients transferred out of the treatment program (1.6%) were associated with HIV status. Excluding deaths, cure rates were similar for HIV-positive and HIV-negative patients (89% versus 88%), but significantly lower in those with recurrent than in those with new TB (77% versus 92%). Mortality was 0.5% in HIV-negative patients versus 13.7% in HIV-positive patients, and in the latter group was associated with CD4(+) lymphocyte depletion. Autopsy examination showed that in HIV-positive patients, early mortality was due to TB whereas late deaths were most commonly due to cryptococcal pneumonia. The study showed that a well-run TB control program can result in acceptable cure rates even in a population with a very high incidence of TB and HIV infection. Particular vigilance is needed for concurrent infections, which may contribute significantly to mortality during treatment of TB in HIV-positive patients.