Antiretroviral therapy for tuberculosis control in nine African countries
Antiretroviral therapy for tuberculosis control in nine African countries
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DOI：
10.1073/pnas.1005660107
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发表时间：
2010-11-09
影响因子：
11.1
通讯作者：
Dye, Christopher
中科院分区：
文献类型：
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作者：
Williams, Brian G.;Granich, Reuben;Dye, Christopher
艾滋病毒使非洲国家的结核病发病率增加了7倍，但抗逆转录病毒疗法降低了艾滋病相关结核病的发病率。我们使用一个数学模型来研究抗逆转录病毒疗法对结核病发病率的短期和长期影响，假设人们平均每年接受一次艾滋病毒检测，并在艾滋病毒血清转换后的固定时间或在固定的CD 4（+）细胞计数时开始抗逆转录病毒疗法。我们将该模型与撒哈拉以南非洲9个国家的艾滋病流行率和结核病发病率趋势数据进行了拟合。如果艾滋病毒阳性者在血清转换后5年内开始抗逆转录病毒治疗，2015年艾滋病相关结核病的发病率将降低48%（范围：37-55%）。如果在艾滋病毒血清转换后5年、2年或1年开始治疗，或者在艾滋病毒检测呈阳性后立即开始治疗，2050年的发病率将降低66%。（范围：57-80%）、95%（范围：93-96%）、97.7%（范围：96.9-98.2%）和98.4%（范围：97.8-98.9%）。在这里考虑的国家中，早期抗逆转录病毒疗法可以在2010年至2015年期间避免340万例结核病病例中的71 +/- 0.36 [95%置信区间（CI）]万例，在2015年至2050年期间避免1500万例结核病病例中的580 +/-290万例（95% CI）。随着越来越多的国家在较高的CD 4（+）细胞计数下提供抗逆转录病毒疗法，应调查其对结核病的影响，以检验该模型的预测。
HIV has increased the incidence of tuberculosis (TB) by up to sevenfold in African countries, but antiretroviral therapy (ART) reduces the incidence of AIDS-related TB. We use a mathematical model to investigate the short-term and long-term impacts of ART on the incidence of TB, assuming that people are tested for HIV once a year, on average, and start ART at a fixed time after HIV seroconversion or at a fixed CD4(+) cell count. We fit the model to trend data on HIV prevalence and TB incidence in nine countries in sub-Saharan Africa. If HIV-positive people start ART within 5 y of seroconversion, the incidence of AIDS-related TB in 2015 will be reduced by 48% (range: 37-55%). Long-term reductions depend sensitively on the delay to starting ART. If treatment is started 5, 2, or 1 y after HIV seroconversion, or as soon as people test positive, the incidence in 2050 will be reduced by 66% (range: 57-80%), 95% (range: 93-96%), 97.7% (range: 96.9-98.2%) and 98.4% (range: 97.8-98.9%), respectively. In the countries considered here, early ART could avert 0.71 +/- 0.36 [95% confidence interval (CI)] million of 3.4 million cases of TB between 2010 and 2015 and 5.8 +/- 2.9 (95% CI) million of 15 million cases between 2015 and 2050. As more countries provide ART at higher CD4(+) cell counts, the impact on TB should be investigated to test the predictions of this model.