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首页> 外文期刊>AIDS >Tuberculosis among people with HIV infection in the United Kingdom: opportunities for prevention?
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Tuberculosis among people with HIV infection in the United Kingdom: opportunities for prevention?

机译：英国艾滋病毒感染者中的结核病：预防的机会？

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OBJECTIVE: To investigate the incidence of, and risk factors for, tuberculosis among HIV clinic attendees in the United Kingdom. DESIGN AND METHODS: Observational cohort study of 27 868 individuals in the United Kingdom Collaborative HIV Cohort collaboration, 1996-2005. RESULTS: Among individuals not taking combination antiretroviral therapy (cART), tuberculosis incidence was considerably higher among individuals of black African vs. white or other ethnicities {incidence rates 9.9 [95% confidence intervals (CIs) 7.2, 12.6], 2.5 [95% CI 1.8, 3.0] and 4.4 [95% CI 2.7, 6.0] episodes per 1000 person-years, respectively}. Tuberculosis incidence decreased with time after starting cART; among black Africans, incidence was consistently higher and remained substantial (5.3 per 1000 person-years) at 24 months and longer after starting cART. The strongest independent risk factors for tuberculosis after cART start were most recent CD4 cell count: adjusted rate ratios (aRR) 10.65 (95% CI 6.11, 18.57), 3.40 (95% CI 2.05, 5.65), 1.77 (95% CI 1.06, 2.96) and 1.84 (95% CI 1.09, 3.12) for individuals with CD4 cell counts less than 50, 50-199, 200-349 and 350-499 cells/microl, respectively, compared with at least 500 cells/microl; and black African vs. white ethnicity [aRR 2.93 (95% CI 1.89, 4.54)]. HIV risk group, shorter time on cART, later calendar period and unsuppressed viral load were also independently associated with incident tuberculosis. CONCLUSIONS: Tuberculosis incidence among people attending UK HIV clinics is substantial, particularly among those with non-white ethnicity and low CD4 cell counts, even after starting cART. Earlier HIV diagnosis is needed in order to implement interventions to prevent tuberculosis; tuberculosis preventive therapy should be considered in addition to cART.
机译：目的：调查英国HIV诊所参加者中结核病的发生率和危险因素。设计与方法：1996年至2005年在英国艾滋病毒合作研究队列合作研究中对27 868名个体进行了观察性队列研究。结果：在未接受联合抗逆转录病毒疗法（cART）的个体中，非洲黑人与白人或其他族裔个体的结核病发病率显着更高（发生率9.9 [95％置信区间（CIs）7.2，12.6]，2.5 [95％每1000人年的CI分别为CI 1.8、3.0]和4.4 [95％CI 2.7、6.0]集}。开始cART后，结核病发病率随时间降低;在非洲黑人中，发病率一直较高，在开始使用cART后的24个月及更长的时间内仍然很高（每千人年5.3）。 cART开始后结核病的最强独立危险因素是最近的CD4细胞计数：调整比率（aRR）10.65（95％CI 6.11，18.57），3.40（95％CI 2.05，5.65），1.77（95％CI 1.06， CD4细胞计数分别低于50、50-199、200-349和350-499细胞/微升的个体分别为2.96）和1.84（95％CI 1.09、3.12），而至少500细胞/微升;和非洲黑人与白人种族[aRR 2.93（95％CI 1.89，4.54）]。 HIV高危人群，较短的cART时间，较晚的日历期以及未抑制的病毒载量也独立地与结核病相关。结论：在英国HIV诊所就诊的人中，结核病的发病率很高，尤其是那些非白人，CD4细胞计数低的人，即使开始接受cART治疗后也是如此。为了进行干预以预防结核病，需要及早诊断艾滋病毒;除cART外，还应考虑结核病预防治疗。

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