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Tuberculosis after one year of combination antiretroviral therapy in Nigeria: A retrospective cohort study

机译：尼日利亚联合抗逆转录病毒治疗一年后的结核病：一项回顾性队列研究

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Our objective was to determine tuberculosis (TB) incidence and evaluate TB risk in adults after one or more years of use of combination antiretroviral therapy (cART) through a retrospective cohort study in Jos, Nigeria. We studied a cohort of HIV-infected adults treated with ART for at least 1 year. Based on immunologic and virologic responses to ART, patients were categorized into four groups: CD4 T cell count ≥350 cells/mm3 and HIV-1 RNA level ≤400 copies/ml (group 1), CD4 T cell count ≥350 cells/mm3 and HIV-1 RNA level 400 copies/ml (group 2), CD4 T cell count 350 cells/mm3 and HIV-1 RNA level ≤400 copies/ml (group 3), and CD4 T cell count 350 cells/mm3 and HIV-1 RNA level 400 copies/ml (group 4). Time to incident TB for the four groups was analyzed using the Kaplan-Meier method. Cox regression models were used to evaluate predictors of incident TB. In this cohort of 5,093 HIV-infected adults, of which 68.4% were female, with a mean age 35.1 years (standard deviation 9.1 years), we observed 98 cases of incident TB during 4 years and 3 months of follow-up. The overall TB incidence rate was 8.7 cases/1,000 patient-years of follow-up. Adjusted hazards for incident TB were 2.11 (95% CI 0.97-4.61), 2.05 (95% CI 1.10-3.79), and 3.65 (95% CI 1.15-5.06) in group 2, 3, and 4 patients, respectively, compared to group 1. Tuberculosis incidence in patients on ART is driven by poor immunologic and/or virologic response. Optimization of HIV treatment should be prioritized to reduce the burden of TB in this high-risk population.
机译：我们的目标是通过在尼日利亚乔斯进行的一项回顾性队列研究，确定使用抗逆转录病毒疗法（cART）联合治疗一年或一年以上后成人的结核病（TB）发病率并评估其结核病风险。我们研究了接受ART治疗至少一年的一组HIV感染成年人。根据对ART的免疫和病毒学应答，将患者分为四组：CD4 T细胞计数≥350细胞/ mm3和HIV-1 RNA水平≤400拷贝/ ml（第1组），CD4 T细胞计数≥350细胞/ mm3 HIV-1 RNA水平> 400拷贝/ ml（第2组），CD4 T细胞计数<350细胞/ mm3和HIV-1 RNA水平≤400拷贝/ ml（第3组）和CD4 T细胞计数<350细胞/ mm3 mm3和HIV-1 RNA水平> 400拷贝/毫升（第4组）。使用Kaplan-Meier方法分析了四组的TB发病时间。使用Cox回归模型评估发生结核病的预测指标。在这一队列的5,093名受HIV感染的成年人中，女性为68.4％，平均年龄为35.1岁（标准差为9.1岁），我们在4年和3个月的随访中观察到98例结核病病例。总体结核病发病率为8.7例/ 1,000患者-年的随访。与第2组，第3组和第4组患者相比，调整后的TB患病风险分别为2.11（95％CI 0.97-4.61），2.05（95％CI 1.10-3.79）和3.65（95％CI 1.15-5.06）。第一组。接受抗逆转录病毒疗法的患者的结核病发病率是由于免疫和/或病毒学应答较差所致。应优先考虑优化HIV治疗，以减轻这一高危人群的结核病负担。

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