To the Editors:
结核病(TB)和艾滋病毒共同感染是撒哈拉以南非洲的公共卫生优先权,其中TB是艾滋病毒感染患者中死亡的主要原因,以及艾滋病毒感染的第一次表现。1-3.。一个前所未有的全球努力允许在非洲的抗逆转录病毒治疗中获得越来越多的努力,其中> 200万人在2007年底接受了高活性的抗逆转录病毒治疗(HAART)1。
There is evidence that HAART reduces the risk of TB, in both industrialised4.and resource-limited countries in sub-Saharan Africa and south-east Asia5.-9.。然而,没有关于HAART对不同TB形式的发生率的影响的信息(痰涂片阳性肺(SSP-PTB),痰涂片阴性(SSN-PTB)和外肺(EPTB))。
We have measured TB incidence in a retrospective cohort of HIV infected persons who started HAART in four HIV/AIDS treatment centres in Ouagadougou, Burkina Faso. All consecutive HIV-seropositive patients aged ≥15 yrs, TB-free at HAART initiation, with a follow-up of 12 months or longer were included in the analysis. TB diagnosis was based on internationally accepted criteria10.。Pulmonary TB (PTB) was diagnosed by microscopy (SSP-PTB) or, in the case of SSN-PTB, on algorithms requiring all the following criteria: 1) chest radiography compatible with active TB; 2) unresponsiveness to ≥1 course of large-spectrum antibiotic; and 3) clinician's decision to prescribe a full course of anti-TB therapy. EPTB was based on the clinician's decision to prescribe a full course of anti-TB therapy on the basis of evocative clinical signs, radiological findings and biochemistry of body fluids. Routine culture forMycobacterium tuberculosis在布基纳法索不提供。
将2,383个HIV-血清阳性人的群组进行平均836.1±443.4天。一半以上被归类为世界卫生组织(世卫组织)第III阶段或IV,83%的CD4细胞计数<200细胞·μL-1at HAART initiation. A total of 70 TB cases were diagnosed, including 18 (26%) SSP-PTB, 25 (36%) SSN-PTB and 27 (38%) EPTB. Among the 27 EPTB cases, the most frequent TB sites were lymph node (12 (44%) cases), pleura (5 (18.5%) cases) and peritoneum (4 (15%) cases).
在HAART的第一个三个月(95%置信区间(CI)1.60-4.54)中,TB发病率下降至每100人的0.05(95%CI 0.01-0.16)案件-1·年-1在SSN-PTB患者的开始后≥12个月,从1.40(95%CI 0.60-2.75)到0.05(95%CI 0.01-0.16)每100人-1·年-1在SSP-PTB患者中,1.57(95%CI 0.72-2.99)至每100人的0.07例(95%CI 0.02-0.19)-1·年-1在EPTB患者中(图1⇓).
![图。1-](http://www.qdcxjkg.com/content/erj/32/6/1668/F1.medium.gif)
Incidence of tuberculosis (TB) among HIV seropositive patients (cases per 100 persons-1·Yrs.-1)在2005 - 2007年期间在Burkina Faso发起高度活跃的抗逆转录病毒治疗和疾病现场的定时。•:痰涂片阳性肺结核(PTB);▪:痰涂抹阴性PTB;▴:外肺Tb。
The present study results demonstrate that there are two times more SSN-PTB than SSP-PTB during early HAART. The decreasing trend was similar for SSP-PTB and SSN-PTB; because the former is a specific indicator for TB incidence, therefore most SSN-PTB patients (being diagnosed largely on radiological ground) were likely to be true TB cases. EPTB incidence also showed a declining trend, an important clue in resource-limited countries considering the high cost and complexity of instruments necessary for the diagnosis and follow-up of such cases.
资源限制环境中的国家TB程序应注意,在初始HAART阶段产生的大多数情况是显微镜检查中的PTB病例。采用严格的诊断标准可能导致TB的诊断粗糙。高SSN-PTB发病率意味着增加工作量,因为这种情况的诊断明显更大。虽然被提倡文化增加了微生物敏感性3.那the fragile health infrastructure in most resource-limited settings seems to make this an unrealistic goal in the midterm. Radiological facilities should as a minimum be strengthened. Finally, research on differential diagnosis of suspect EPTB cases and the identification of appropriate diagnostic procedures for this condition is warranted.
总体而言,在早期高度活跃的抗逆转录病毒治疗期间结核病发病率高,大多数病例呈现阴性显微镜,清楚地表明资源限制的环境中的艾滋病毒计划需要更多地对结核病诊断和注意力降低个体发病率和死亡率并预防病态的医院传播。
兴趣表
None declared.
Acknowledgments
The present authors would like to thank D.A. Hien, I. Zabsonre, T.S. Koala, J. Simporé and B. Cauchoix for their contribution to study design and data collection; R. Centis for revising the manuscript; and the Global Fund, Grant BUR 404-T for financial support.
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