Reducing tuberculosis incidence by tuberculin skin testing, preventive treatment, and antiretroviral therapy in an area of low tuberculosis transmission
Reducing tuberculosis incidence by tuberculin skin testing, preventive treatment, and antiretroviral therapy in an area of low tuberculosis transmission
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DOI：
10.1086/510080
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发表时间：
2007-01-01
影响因子：
11.8
通讯作者：
Furrer, Hansjakob
中科院分区：
文献类型：
--
作者：
Elzi, Luigia;Schlegel, Matthias;Furrer, Hansjakob
背景。建议所有人类免疫缺陷病毒 (HIV) 感染者进行结核菌素皮试 (TST) 和结核病 (TB) 预防性治疗。我们的目的是评估在结核病传播率低的地区进行联合抗逆转录病毒治疗时代，TST 和结核病预防性治疗对结核病发病率的影响。方法。我们计算了 1995 年后进入瑞士艾滋病队列研究的参与者的结核病发病率，并研究了 TST 结果、流行病学和实验室标志物、预防性结核病治疗以及联合抗逆转录病毒治疗与结核病发病率的关联。结果。在 6160 名参与者中，142 人 (2.3%) 在研究开始时有结核病史，56 人 (0.91%) 在 25,462 人年的总随访期内发展为结核病，相当于每 100 人年 0.22 例发病率。 69% 的患者进行了 TST； 9.4% 的测试患者有阳性结果（硬结直径 >= 5 毫米）。在 TST 结果呈阳性的患者中，如果不进行预防性治疗，结核病发病率为每 100 人年 1.6 例，但接受预防性治疗的 193 名患者中没有一人发展为结核病。 TST 结果阳性（调整后风险比 [HR]，25；95% 置信区间 [CI]，11-57）、TST 结果缺失（HR，12；95% CI，4.8-20）、来自撒哈拉以南非洲地区（HR，5.8；95% CI，2.7-12.5）、低 CD4(+) 细胞计数和高血浆 HIV RNA 水平与以下风险增加相关：结核病，而接受联合抗逆转录病毒治疗的患者风险降低（HR，0.44；95% CI，0.2-0.8）。结论。在结核病传播率较低的地区，使用 TST 筛查潜伏性结核病并对 TST 结果呈阳性的患者进行预防性治疗是降低结核病发病率的有效策略。联合抗逆转录病毒治疗可降低结核病的发病率。
Background. Tuberculin skin testing (TST) and preventive treatment of tuberculosis (TB) are recommended for all persons with human immunodeficiency virus (HIV) infection. We aimed to assess the effect of TST and preventive treatment of TB on the incidence of TB in the era of combination antiretroviral therapy in an area with low rates of TB transmission.Methods. We calculated the incidence of TB among participants who entered the Swiss HIV Cohort Study after 1995, and we studied the associations of TST results, epidemiological and laboratory markers, preventive TB treatment, and combination antiretroviral therapy with TB incidence.Results. Of 6160 participants, 142 (2.3%) had a history of TB at study entry, and 56 (0.91%) developed TB during a total follow-up period of 25,462 person-years, corresponding to an incidence of 0.22 cases per 100 person-years. TST was performed for 69% of patients; 9.4% of patients tested had positive results (induration >= 5 mm in diameter). Among patients with positive TST results, TB incidence was 1.6 cases per 100 person-years if preventive treatment was withheld, but none of the 193 patients who received preventive treatment developed TB. Positive TST results (adjusted hazard ratio [HR], 25; 95% confidence interval [CI], 11-57), missing TST results (HR, 12; 95% CI, 4.8-20), origin from sub-Saharan Africa (HR, 5.8; 95% CI, 2.7-12.5), low CD4(+) cell counts, and high plasma HIV RNA levels were associated with an increased risk of TB, whereas the risk was reduced among persons receiving combination antiretroviral therapy (HR, 0.44; 95% CI, 0.2-0.8).Conclusion. Screening for latent TB using TST and administering preventive treatment for patients with positive TST results is an efficacious strategy to reduce TB incidence in areas with low rates of TB transmission. Combination antiretroviral therapy reduces the incidence of TB.