Incidence and risk factors for tuberculosis in HIV-infected patients while on antiretroviral treatment in Cambodia
Incidence and risk factors for tuberculosis in HIV-infected patients while on antiretroviral treatment in Cambodia
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DOI：
10.1093/trstmh/trt001
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发表时间：
2013-04-01
影响因子：
2.2
通讯作者：
van Griensven, Johan
中科院分区：
文献类型：
--
作者：
Choun, Kimcheng;Thai, Sopheak;van Griensven, Johan
鉴于缺乏对东南亚接受抗逆转录病毒治疗的患者的结核病的详细研究，我们的目的是确定早期糖尿病的发病率和危险因素，我们对金边一家非政府医院（2003年3月至2010年12月）开始接受抗逆转录病毒治疗的所有患者进行了回顾性分析。结核病诊断是根据世界卫生组织的算法进行的。使用多变量考克斯回归模型进行风险因素分析。总体而言，2984例患者开始接受ART治疗。中位基线CD 4计数为89个细胞l（1）（IQR 25209），中位年龄为34岁（IQR 2940）。53%的患者是女性。ART的中位随访时间为2.4年。除了932（31.2）例在ART开始时已接受TB治疗的患者外，313（10.5）例患者发生TB，总发病率为3.9/100患者-年。在患有结核病的患者中，179例（6.0）患者被诊断为早期结核病，134例（4.5）患者被诊断为晚期结核病，相应的发病率分别为每100患者年13.5例和2.0例。早期结核病的危险因素包括低体重指数、低基线CD 4计数和低血红蛋白水平。低治疗CD 4计数和血红蛋白水平，体重不足，而ART和流行的TB被确定为晚期TB的危险因素。早期TB的发病率很高，主要与晚期HIV进展标志物相关。在开始抗逆转录病毒治疗之前和之后，需要更早地开始抗逆转录病毒治疗并加强结核病筛查。晚期结核病几乎占结核病总负担的一半，需要采取具体的预防和诊断方法。
Given the lack of detailed studies on tuberculosis (TB) in patients on antiretroviral treatment (ART) in South-East Asia, we aimed to determine the incidence and risk factors for early (after 6 months of ART) and late (after 6 months of ART) incident TB in Cambodia.We conducted a retrospective analysis of all patients started on ART at a non-governmental hospital in Phnom Penh (March 2003December 2010). TB diagnosis was performed according to WHO algorithms. Risk factor analysis was performed using multivariate Cox regression modeling.Overall, 2984 patients started ART. The median baseline CD4 count was 89 cells l(1) (IQR 25209), median age 34 years (IQR 2940). Fifty-three percent of the patients were female. Median follow-up time on ART was 2.4 years. In addition to 932 (31.2) patients already on TB treatment at ART initiation, 313 (10.5) developed TB, with an overall incidence rate of 3.9/100 patient-years. Of those developing TB, 179 (6.0) patients were diagnosed with early TB and 134 (4.5) with late TB, corresponding with a rate of 13.5 and 2.0 per 100 patient-years respectively. Risk factors for early TB included low body mass index, low baseline CD4 count and low hemoglobin levels. Low on-treatment CD4 counts and hemoglobin levels, being underweight while on ART and prevalent TB were identified as risk factors for late TB.The incidence of early TB was high, and predominantly associated with advanced HIV progression markers. Earlier ART initiation and enhanced TB screening prior to and after ART initiation is warranted. Late TB amounts to almost half of the total TB burden, meriting specific preventive and diagnostic approaches.