Tuberculosis after HAART initiation in HIV-positive patients from five countries with a high tuberculosis burden
Tuberculosis after HAART initiation in HIV-positive patients from five countries with a high tuberculosis burden
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DOI：
10.1097/01.aids.0000232235.26630.ee
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发表时间：
2006-06-12
期刊：
影响因子：
3.8
通讯作者：
Ferradini, Laurent L. F.
中科院分区：
文献类型：
--
作者：
Bonnet, Maryline M. B.;Pinoges, Loretxu L. P.;Ferradini, Laurent L. F.
背景：HAART降低了艾滋病毒/艾滋病患者的结核病发病率，但那些开始HAART的人可能会发展为活动性结核病或亚临床结核病，这可能在免疫重建炎症综合征中变得明显。目的：测量在结核病/艾滋病毒负担高的资源匮乏国家的五个艾滋病毒规划中接受HAART治疗的人群中通报结核病的发病率。方法：对无国界医生组织的5个项目（柬埔寨、泰国、肯尼亚、马拉维和喀麦隆）进行回顾性分析，根据开始HAART治疗后的随访时间计算通报结核病的发病率。结果：在分析的3151例患者中，90%的患者CD4细胞计数< 200细胞/ μ l。中位随访时间从泰国或肯尼亚的3.7个月到柬埔寨的11.1个月不等。在柬埔寨、泰国、肯尼亚、马拉维和喀麦隆的项目中，肺结核的发病率分别为7.6、10.4、17.6、14.3和4.8/100人年，肺外结核的发病率分别为12.7、4.3、6.9、2.1和0/100人年。总体而言，62.3%的肺结核和54.9%的肺外结核在HAART开始后3个月内被诊断出来。结论：在资源贫乏国家开展的高效抗逆转录病毒疗法规划中，结核病通报发病率较高；这些可能包括在HAART开始时未确诊的流行结核病和在免疫重建炎症综合征期间发生的亚临床结核病。这就提出了与结核病/艾滋病毒合并感染患者的结核病诊断和治疗有关的业务问题，并促使紧急整合结核病和艾滋病毒护理。(c) 2006年Lippincott Williams & Wilkins。
Background: HAART reduces tuberculosis (TB) incidence in people living with HIV/AIDS but those starting HAART may develop active TB or subclinical TB may become apparent in the immune reconstitution inflammatory syndrome.Objective: To measure the incidence rate of notified TB in people receiving HAART in five HIV programmes occurring in low-resource countries with a high TB/HIV burden. Methods: A retrospective review in five Medecins Sans Frontieres programmes (Cambodia, Thailand, Kenya, Malawi and Cameroon) allowed incidence rates of notified TB to be calculated based on follow-up time after HAART initiation.Results: Among 3151 patients analysed, 90% had a CD4 cell count of < 200 cells/mu l. Median follow-up time ranged from 3.7 months in Thailand or Kenya to 11.1 months in Cambodia. Incidence rates were 7.6, 10.4, 17.6, 14.3 and 4.8/100 person-years for pulmonary TB and 12.7, 4.3, 6.9, 2.1 and 0/100 person-years for extra-pulmonary TB in the programmes in Cambodia, Thailand, Kenya, Malawi and Cameroon, respectively. Overall, 62.3% of pulmonary TB and 54.9% of extra-pulmonary TB were diagnosed within 3 months after HAART initiation.Conclusion: High incidence rates of notified TB under HAART in programmes held in poor-resource countries were observed; these were likely to include both undiagnosed prevalent TB at HAART initiation and subclinical TB developing during the immune reconstitution inflammatory syndrome. This raises operational issues concerning TB diagnosis and treatment of TB/HIV-coinfected patients and prompts for urgent TB and HIV care integration. (c) 2006 Lippincott Williams & Wilkins.