RISK-FACTORS FOR TUBERCULOSIS IN HIV-INFECTED PERSONS - A PROSPECTIVE COHORT STUDY
RISK-FACTORS FOR TUBERCULOSIS IN HIV-INFECTED PERSONS - A PROSPECTIVE COHORT STUDY
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DOI：
10.1001/jama.274.2.143
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发表时间：
1995-07-12
影响因子：
120.7
通讯作者：
IPPOLITO, G
中科院分区：
文献类型：
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作者：
ANTONUCCI, G;GIRARDI, E;IPPOLITO, G
目的：-分析人口统计学、临床和实验室特征如何影响人类免疫缺陷病毒(HIV)感染者患结核病的风险；检查HIV感染者、结核菌素阴性、无过敏个体的结核病发病率与皮试反应性变化的关系。设计-多中心队列研究。设置-意大利公立医院的23个感染科。受试者-3397名HIV感染者的连续样本被考虑进入该研究。在这些人中，2695人被跟踪至少4周；739名受试者(27.4%)无法进行随访。中位随访时间为91周。主要结果。-培养证实的结核病。结果。-观察到83例结核病。结核病发病率分别为5.42/百人年、3.00/百人年、0.45/百人年。在多因素分析中，结核菌素阳性(危险比，9.94；95%可信区间[CI]，3.84~25.72)或无能(HR，3.35；95%CI，1.40~8.00)，或CD_4(+)淋巴细胞计数<0.20x10(9)/L(HR，4.87；95%CI，2.35~10.11)或介于0.20至0.35×10(9)/L(HR，2.35；95%CI，1.09~5.05)与肺结核发病风险显著相关，不同皮试反应性的三组受试者中，随着CD4(+)淋巴细胞水平的降低，肺结核发病率增加。604例结核菌素阴性的无能受试者在入选1年后再次进行皮肤试验；在13名转为结核菌素反应的受试者中观察到3例结核病。结论：联合考虑皮试反应和CD4(+)淋巴细胞计数可以更准确地量化HIV感染者患结核病的风险。对结核菌素阴性、无过敏的患者进行定期皮肤测试，有助于确定活动性肺结核的高危人群。
Objective.-To analyze how demographic, clinical, and laboratory characteristics influence the risk of tuberculosis in human immunodeficiency virus (HIV)infected individuals; to examine the incidence of tuberculosis associated with change in skin test responsiveness in HIV-infected, tuberculin-negative, nonanergic individuals.Design.-Multicenter cohort study.Setting.-Twenty-three infectious disease units in public hospitals in Italy.Subjects.-A consecutive sample of 3397 HIV-infected subjects were considered for entry in the study. Of these, 2695 who were followed up for at least 4 weeks were enrolled in the study; 739 subjects (27.4%) were unavailable for follow-up. The median duration of follow-up was 91 weeks.Main Outcome Measure.-Culture-proven tuberculosis.Results.-Eighty-three episodes of tuberculosis were observed. Incidence rates of tuberculosis were 5.42 per 100 person-years among tuberculin-positive subjects, 3.00 per 100 person-years among anergic subjects, and 0.45 per 100 person-years among tuberculin-negative nonanergic subjects. In multivariate analysis, being tuberculin-positive (hazard ratio [HR], 9.94; 95% confidence interval [CI], 3.84 to 25.72) or anergic (HR, 3.35; 95% CI, 1.40 to 8.00), or having a CD4(+) lymphocyte count less than 0.20x10(9)/L (HR, 4.87; 95% CI, 2.35 to 10.11) or between 0.20 and 0.35x10(9)/L (HR, 2.35; 95% CI, 1.09 to 5.05) were statistically significantly associated with the risk of tuberculosis, Incidence of tuberculosis increased with decreasing levels of CD4(+) lymphocytes in the three groups of subjects with different skin test responsiveness. Skin tests were repeated 1 year after enrollment in 604 tuberculin-negative nonanergic subjects; three cases of tuberculosis were observed among the 13 subjects who converted to tuberculin reactivity.Conclusions.-Risk of tuberculosis in HIV-infected persons can be more precisely quantified by jointly considering skin test reactivity and CD4(+) lymphocyte count. Periodic skin tests in tuberculin-negative nonanergic individuals can be useful in identifying individuals at high risk of active tuberculosis.