Undiagnosed Tuberculosis Among HIV Clinic Attendees: Association With Antiretroviral Therapy and Implications for Intensified Case Finding, Isoniazid Preventive Therapy, and Infection Control
Undiagnosed Tuberculosis Among HIV Clinic Attendees: Association With Antiretroviral Therapy and Implications for Intensified Case Finding, Isoniazid Preventive Therapy, and Infection Control
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DOI：
10.1097/qai.0b013e318251ae0b
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发表时间：
2012-06-01
影响因子：
3.6
通讯作者：
Gounder, Celine R.
中科院分区：
文献类型：
--
作者：
Kufa, Tendesayi;Mngomezulu, Victor;Gounder, Celine R.
目的：开始抗逆转录病毒治疗（ART）和3I是预防艾滋病毒相关结核病（TB）的策略。我们描述了在南非HIV诊所就诊的HIV感染患者中与未确诊结核病相关的因素，并讨论了3is的影响。设计：方便HIV门诊参会者的样本。方法：使用症状筛查、痰涂片镜检、痰和血分枝杆菌培养、细针穿刺肿大淋巴结和胸部x线摄影评估hiv感染参与者的结核病。结果：共纳入422名受试者。中位年龄和CD4+ t细胞计数为37岁[四分位数范围（IQR）： 31-44岁]，每微升215个细胞（IQR: 107-347个细胞/ μ L）。47%的患者接受抗逆转录病毒治疗的中位时间为8个月（IQR: 3.3-22.8个月）。361名参与者（85.6%）报告了结核病症状。27名参与者（6.4%）符合细菌学确诊结核病的标准，50名（11.6%）符合任何形式结核病的标准。细菌学证实结核病与CD4+ t细胞计数200个/微升和血红蛋白{血红蛋白< 10 g/dL[优势比3.12(95%可信区间：1.26 ~ 7.72)]}相关。结论：无论抗逆转录病毒治疗状态如何，hiv感染的门诊患者中未确诊的结核病与CD4+ t细胞计数低有关。包括CD4+ t细胞计数和血红蛋白检测在内的结核病筛查算法可能是一种有效的方法，可以识别hiv感染的临床参与者，其未确诊结核病的风险最高。异烟肼预防治疗和结核感染控制对于减少艾滋病毒相关结核的发生至关重要，即使在抗逆转录病毒治疗开始后也是如此。
Objectives: Initiation of antiretroviral therapy (ART) and the 3I's are strategies to prevent HIV-associated tuberculosis (TB). We describe factors associated with undiagnosed TB among HIV-infected patients attending an HIV clinic in South Africa and discuss implications for the 3 Is.Design: Convenience sample of HIV clinic attendees.Methods: HIV-infected participants were assessed for TB using a symptom screen, sputum-smear microscopy, sputum and blood mycobacterial culture, fine needle aspiration of enlarged lymph nodes, and chest radiography.Results: Four hundred twenty-two participants were enrolled. The median age and CD4+ T-cell count were 37 years [interquartile range (IQR): 31-44 years] and 215 cells per microliter (IQR: 107-347cells/mu L). Forty-seven percent had been on ART for a median duration of 8 months (IQR: 3.3-22.8 months). Three hundred sixty-one participants (85.6%) reported TB symptoms. Twenty-seven participants (6.4%) met criteria for bacteriologically confirmed TB and 50 (11.6%) for any form of TB. Bacteriologically confirmed TB was associated with CD4+ T-cell counts 200 cells per microliter and hemoglobin {hemoglobin < 10 g/dL [odds ratio 3.12 (95% confidence interval: 1.26 to 7.72)]}.Conclusions: Undiagnosed TB among HIV-infected ambulatory patients was associated with low CD4+ T-cell counts regardless of ART status. TB screening algorithms which include CD4+ T-cell count and hemoglobin testing may be an effective way to identify HIV-infected clinic attendees at highest risk of undiagnosed TB. Isoniazid preventive therapy and TB infection control are essential for reducing occurrence of HIV-associated TB even after ART initiation.