TUBERCULOSIS IN PATIENTS WITH THE ACQUIRED-IMMUNODEFICIENCY-SYNDROME - CLINICAL-FEATURES, RESPONSE TO THERAPY, AND SURVIVAL
TUBERCULOSIS IN PATIENTS WITH THE ACQUIRED-IMMUNODEFICIENCY-SYNDROME - CLINICAL-FEATURES, RESPONSE TO THERAPY, AND SURVIVAL
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DOI：
10.1164/ajrccm/136.3.570
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发表时间：
1987-09-01
期刊：
影响因子：
--
通讯作者：
HOPEWELL, PC
中科院分区：
文献类型：
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作者：
CHAISSON, RE;SCHECTER, GF;HOPEWELL, PC
结核病以前曾在获得性免疫缺陷综合征患者中报告，这些患者既往感染结核分枝杆菌的风险增加。我们使用旧金山弗朗西斯科公共卫生部结核病和艾滋病登记处对旧金山弗朗西斯科的艾滋病和结核病进行了一项基于人群的研究。在1981年至1985年报告的287例非亚洲出生的15至60岁男性结核病病例中，35例（12%）同时患有艾滋病，包括23例美国出生的白人。与没有结核病的艾滋病患者相比，结核病和艾滋病患者更有可能是非白人和异性恋静脉吸毒者。51%的人在艾滋病之前诊断出结核病，37%的人在结核病诊断前至少1个月诊断出艾滋病。尽管肺是艾滋病和非艾滋病患者最常见的结核病部位，但60%的艾滋病患者至少有一个肺外病变部位，而非艾滋病患者为28%（p < 0.001）。无意义的结核菌素皮肤试验在艾滋病患者中（23例受试者中有14例）比非艾滋病患者（129例受试者中有12例; p < 0.0001）更常见。AIDS患者的胸片主要表现为弥漫性或粟粒性浸润（60%），而非AIDS患者主要表现为局灶性浸润和/或空洞（68%）。艾滋病患者抗结核治疗的反应良好，但药物不良反应发生率高于非艾滋病患者（p < 0.02）。总的死亡率很高，几乎总是由艾滋病引起的，从结核病诊断或艾滋病诊断的时间来衡量，没有什么不同。这些数据证实，结核病是一种与艾滋病相关的机会性感染，其特征是不典型的临床特征和生存率低，结核病可能出现在艾滋病诊断后的患者与以前的结核感染的可能性低。
Tuberculosis has been reported previously in patients with acquired immunodeficiency syndrome who are at increased risk of prior infection with Mycobacterium tuberculosis. We performed a population-based study of AIDS and tuberculosis in San Francisco using the Tuberculosis and AIDS Registries of the San Francisco Department of Public Health. Of 287 cases of tuberculosis in non-Asian-born males 15 to 60 yr of age reported from 1981 through 1985, 35 (12%) also had AIDS, including 23 American-born whites. Patients with tuberculosis and AIDS were more likely to be nonwhite and heterosexual intravenous drug users than were AIDS patients without tuberculosis. Fifty-one percent had tuberculosis diagnosed before AIDS, and 37 percent had AIDS diagnosed at least 1 month prior to the diagnosis of tuberculosis. Although the lungs were the most frequent site of tuberculosis in both AIDS and non-AIDS patients, 60% of the AIDS group had at least 1 extrapulmonary site of disease compared to 28% of the non-AIDS group (p < 0.001). Nonsignificant tuberculin skin tests were more common in AIDS patients (14 of 23 patients tested) than in non-AIDS patients (12 of 129 patients tested; p < 0.0001). Chest radiographs in AIDS patients showed predominantly diffuse or miliary infiltrates (60%), whereas non-AIDS patients had predominantly focal infiltrates and/or cavitation (68%). Response to antituberculosis therapy was favorable in AIDS patients, although adverse drug reactions occurred more frequently than in non-AIDS patients (p < 0.02). Overall mortality was high, was almost always caused by AIDS, and did not differ when measured from time of tuberculosis diagnosis or from time of AIDS diagnosis. These data confirm that tuberculosis is an AIDS-related opportunistic infection characterized by atypical clinical features and poor survival, and that tuberculosis may appear after AIDS is diagnosed in patients with a low likelihood of prior tuberculous infection.