Antiretroviral therapy during tuberculosis treatment and marked reduction in death rate of HIV-infected patients, Thailand

Antiretroviral therapy (ART) is lifesaving in patients with advanced HIV infection, but the magnitude of benefit in HIV-infected patients receiving tuberculosis (TB) treatment remains uncertain, and population-based data from developing countries are limited. We prospectively collected data about HIV-infected TB patients from February 2003 through January 2004 in Ubon-ratchathani, Thailand. During 12 months, HIV was diagnosed in 329 (14%) of 2,342 patients registered for TB treatment. Of patients with known outcomes, death during TB treatment occurred in 5 (7%) of 71 who received ART and 94 (43%) of 219 who did not. Using multivariate analysis, we found a large reduction in the odds of death for patients receiving ART before or during TB treatment (odds ratio, 0.2; 95% confidence interval, 0.1-0.5), adjusting for CD4 count, smear status, co-trimoxazole use, and treatment facility. ART is associated with a substantial reduction in deaths during TB treatment for HIV-infected TB patients in Thailand.     

Factors associated with mortality and default among patients with tuberculosis attending a teaching hospital clinic in Accra, Ghana

Tuberculosis (TB) remains a major cause of mortality despite availability of effective chemotherapy. This study was performed to identify contributing factors for poor outcome during anti-tuberculosis treatment at a teaching hospital chest clinic. Medical records of registered patients treated for TB between 1 January and 31 December, 2009 were reviewed and abstracted for demographic, clinical and outcome data. Risk factors for mortality during therapy were assessed using bivariate and multivariate logistics approaches. Of 599 patients, 355 (58.9%) completed therapy and/or were cured, 192 (32.1%) died, and 39 (6.5%) defaulted. In multivariate analysis, independent risk factors for mortality included pulmonary cases for which sputum smear status was unknown (odds ratio [OR] 13.7; 95% confidence interval [CI] 6.0, 31.4), HIV coinfection (OR, 3.6; 95% CI 2.4, 5.4), disseminated TB (OR, 2.2; 95% CI 1.0, 4.9), TB meningitis (OR, 2.8; 95% CI 1.5, 5.3), not having a treatment supporter (OR, 2.0; 95% CI 1.3, 3.1), and low body weight (OR, 11.0; 95% CI 3.1, 38.6). Not having a treatment supporter (OR, 3.2; 95% CI 1.6, 6.6) and HIV coinfection (OR, 2.4; 95% CI 1.2, 5.2) were also independently associated with treatment default. Our findings suggest that enhanced measures to reduce mortality and default in TB patients with HIV coinfection, disseminated or meningeal disease and those who have no treatment supporters may help improve treatment outcomes in Ghana.     

Factors associated with tuberculosis treatment default and completion at the Effia-Nkwanta Regional Hospital in Ghana

The level of defaulting from treatment among tuberculosis (TB) patients at the Effia-Nkwanta Regional Hospital between January 2000 and December 2001 was 13.9%. This study was therefore designed to assess factors associated with TB treatment default and completion at the hospital. The initial part of the study consisted of three separate focus group discussions for health workers, defaulters and non-defaulters. The information collected was used to design a questionnaire that was administered to defaulters and non-defaulters selected from the Institutional TB Register. Univariate logistic regression analysis was performed to identify significant factors associated with treatment default. Statistical significance was taken as P < 0.05. Default from treatment was significantly associated with income per month (P = 0.03), ability to afford supplementary drugs (P = 0.008), availability of social support (P = 0.005) and problems relating with others while on treatment (P = 0.01). A cordial relationship between patients and health staff was the main motivating factor for completion of treatment, whilst financial difficulty was the main reason for defaulting from treatment. Determination of the characteristics found to be associated with defaulting in this study among TB patients at the start of treatment may be helpful in improving compliance among patients registered for treatment at the hospital.     

中国结核病控制直接面视下督导化疗的系统评价

目的 评价直接面视下督导化疗（DOT）对结核病病例管理的效果.方法 通过《中国全文期刊网》（CNKI）、万方数据库和Medline数据库检索1994-2004年关于DOT有关文献和资料,并进行系统评价,包括定量分析（Meta分析）和定性分析;评价指标为治愈率.结果 共检索204篇文献,入选120篇.（1）管理措施：全程督导组与全程管理组治愈率合并后率差RD值（95%CI）为0.14（0.06～0.22）,P＜0.000 01.按全程管理执行严格程度进行分层分析,全程督导和管理严格的全程管理组差异无统计学意义（P=0.06）,RD值（95%CI）为0.02（0.00～0.03）,全程督导与未提及是否严格的全程管理组差异有统计学意义（P=0.004）,RD值（95%CI）为0.18（0.06～0.30）,不严格组差异有统计学意义（P＜0.05）,RD值（95%CI）为0.16（0.07～0.24）.全程督导组与自服药组差异有统计学意义（P=0.002）,RD值（95%CI）为0.24（0 10～0.38）.（2）化疗方案：短疗程与长疗程化疗方案治愈率差异有统计学意义（P=0.003）,合并RD值（95%CI）为0.04（0.01～0.07）.结论 只要管理严格,强化对结核病病例的不同管理模式,如全程督导和全程管理,可以使患者达到相同的治疗依从性.患者的依从性与化疗方案、给药方式（每日给药或间歇给药）等因素有关.     

结核病患者艾滋病防治知识知晓情况调查

目的了解结核病患者艾滋病防治知识掌握情况。方法对福建省永安市2008年结核病门诊登记的226名活动性肺结核和肺外结核病患者进行10项艾滋病防治相关知识的问卷调查。结果10项艾滋病相关防治知识总知晓率为68.9%;其中对艾滋病是否可以通过握手传播和艾滋病是否更易患结核病的知晓率较低,分别是55.8%和47.8%;结核病患者中不同文化程度者对艾滋病防治知识知晓率有所差异,文盲患者的知晓率仅为41.3%;不同职业人员对艾滋病防治知识知晓率不同,农民患者的知晓率仅为57.1%。结论结核病患者对艾滋病防治知识的知晓率较低,要大力开展结核病和艾滋病防治知识的宣传,加强结核病和艾滋病防治人员的合作,共同遏制结核病和艾滋病的流行。     

Marital sex among people living with HIV receiving antiretroviral treatment in Northern Thailand

Before the advent of effective antiretroviral treatment (ART), the sexuality of people living with HIV was mostly discussed in terms of risk. To assess the extent to which ART allows people living with HIV to regain a regular sexual life, we surveyed all HIV-infected people treated in four hospitals in Northern Thailand and a control group from the general population matched by sex, age and residence. Data included socio-demographic and health characteristics, frequency of sexual intercourse in the last month and condom use. Our findings indicate that people living with HIV less often live in steady partnership (50% of the HIV-infected people versus 79% of the controls). After adjusting for factors known to influence sexuality, their probability of being sexually active was estimated to be about half that of the controls. When sexually active, men had a reduced sexual activity compared to controls (2.8 intercourse in the last month versus 4.0), while levels of reported sexual activity were similar among women (2.2 versus 2.8, respectively). Consistent condom use was high among people living with HIV (66% for women and 70% for men).     

HIV/AIDS病人预防和治疗结核病双重感染的研究

目的调查HIV/AIDS病人结核菌素(PPD)试验反应状况及与免疫系统受损程度的联系,并探讨其预防和治疗结核病的意义。方法采用前瞻性病例对照研究方法,对40例HIV(+)者和202例HIV(-)者做结核菌素试验,并对HIV(十)者做CD4、CD8细胞计数测定,对HIV(+)分组服药,观察胸部病变情况。结果HIV(+)与HIV(-)者PPD阳性率分别为12.5%、28.2%(P<0.05)。当CD4细胞计数下降时,PPD反应减弱。CD4<200个/mm3时PPD均无反应(0×0).病例服药组经化学药物预防治疗后其肺部病变异常率小于病例对照组。结论HIV(+)者中PPD阳性率显著低于HIV(-)者。CD4细胞数下降可能是艾滋病并发结核的主要原因.对HIV/AIDS患者使用化学药物预防和治疗结核是有效的。     

Directly Observed versus Self-administered Antiretroviral Therapies: Preference of HIV-Positive Jailed Inmates in San Francisco

Directly observed therapy (DOT) of antiretroviral (ARV) medications has beneficial effects on HIV treatment for incarcerated inmates but has been associated with limited continuation after release and inadvertent disclosure of HIV status. Guided self-administered therapy (g-SAT) may be a preferred method of ARV delivery and may encourage medication-taking behavior. We surveyed the preference of 102 HIV-positive jailed inmates at the San Francisco City and County Jails regarding receiving ARVs via DOT versus g-SAT while incarcerated. Participants overwhelmingly preferred g-SAT over DOT.     

重点初治涂阳肺结核病人规范管理方法探讨

目的　探索适合重点初治涂阳肺结核病人的管理方式。方法　选取初治涂阳肺结核病人 ,对重点初治涂阳病人实行规范管理 ,称规范管理组 ,其余实施全程督导 ,称全程督导组 ,两组均采用初治涂阳肺结核病人短程化疗方案 ( 2HRZE/4H 3R 3 ) ,并采用板式组合药 ,观察两种管理方式下病人的疗效及中断治疗情况。结果　规范管理组和全程督导组 2个月痰菌阴转率分别为 97 8%和 97 4% ,疗程结束治愈率分别为 95 6%和 96 6% ,断药率分别为 0 3 %和 0 19% ,差异均无显著性(P >0 .0 5 )。结论　家庭督导式规范管理可获得与以医生为主体的全程督导同样的效果。     

苏北农村耐药结核病现状及影响因素的研究

目的 探讨农村耐药结核病的流行现状与可能的危险因素及保护因素。方法 对实施直接面视下短程化疗(DOTS)的苏北某项目县2002年全部结核病患者和某非项目县同期患者的一个样本进行问卷调查和痰菌培养,对新分离株进行比例法药敏试验,以单因素及多因素非条件logistic回归方法分析资料。结果 共有152例患者的药敏结果可以分析。其中32.9％的病例耐至少1种一线药,26.3％耐异胭肼(INH),18.4％耐利福平(RIF),17.1％同时耐INH和RIF。INH耐药和RIF耐药共同的独立危险因素是结核病治疗史和来自非项目县,而不重视自身健康和就医延误1个月以上的患者更可能耐RIF。耐多药(MDR)的独立预告因素包括:就医延误1个月以上(OR=4.66,95％CI:1.26～17.24)、来自非项目县(OR=3.01,95％CI:1.10～8.22)、不重视健康(OR=5.13,95％CI:1.06～24.90)和患有慢性病(OR=0.22,95％CI:0.05～0.87)。结论 当地农村耐药结核病疫情严重,耐药性主要与人为因素有关,但可能存在一定的传播。     

Quality of life among people living with HIV/AIDS in northern Thailand: MOS-HIV Health Survey

OBJECTIVES: Translation and psychometric evaluation of a Thai version of the Medical Outcomes Study HIV Health Survey (MOS-HIV) in Thailand. METHODS: A cross-sectional survey in Chiang Mai province, northern Thailand, with data collected in face-to-face interviews using a structured questionnaire designed to measure 10 scales of quality of life (QOL). We recruited 200 people with HIV/AIDS attending self-help groups in the municipal area. Standard guidelines were followed for questionnaire translation and psychometric evaluations. RESULTS: Item-level internal consistency and discriminant validity were reasonably established. Success rates were 93.8 and 97.4%, respectively. Scale-level internal consistency reliability of multi-item scales was satisfactory, ranging from 0.74 to 0.88, with all exceeding inter-scale correlations. Principal components analysis of item and scale scores identified two hypothesized dimensions of the MOS-HIV. The mental health component was strongly loaded by health distress, mental health, vitality and cognitive function scales, and physical health by role, physical and social functions, and pain scales. Respondents manifesting symptoms or reporting worsening health status scored significantly lower on all scales. CONCLUSIONS: These preliminary studies have shown the Thai version of the MOS-HIV to have psychometric properties comparable with those reported in previous surveys. Further testing and modification should make it useful as an HIV-specific QOL measure in Thailand.     

中国结核病患者的发现与现代结核病控制策略扩展关系的预测分析

目的 分析影响发现结核病患者的因素,预测2005年中国结核病患者发现的进展情况。方法 描述1996～2003年新涂阳患者登记率和发现率的变化情况;分析新涂阳患者登记率与现代结核病控制策略(DOTS策略)覆盖率之间的相关关系,并建立回归方程,预测2004年和2005年的登记率。结果 1996～1998年全国新涂阳患者的登记率和发现率均呈上升趋势,随后4年处于平稳期,2003年则出现了较大幅度的上升,超过以往各年的最高登记率和发现率;1996～2003年期间新涂阳患者登记率与DOTS覆盖率的变化趋势呈正的直线相关关系(r=0.849,P=0.008),具有较高程度的关联。回归方程为:y=b_0 b_1X=1.754 0.217X,总体回归系数的95％CJ为0.082～0.352,F=15.43,P=0.008;其决定系数R~2=0.72。当2005年DOTS策略覆盖率达到100％时,全国新涂阳患者的登记率为23.5/10万,其95％CI为10.0～37.0;由此推算,全国新涂阳患者的发现率为51.8％,其95％CI为22.0～81.5(2005年患者发病率估算为45.4/10万)。结论 DOTS策略的扩展能够促进结核病患者的发现,但更为重要的是DOTS策略的实施质量对于结核病患者的发现起着至关重要的作用。     

结核病人拒绝HIV检测的原因及人口学特征分析

目的分析拒绝HIV抗体检测的结核病人特征,揭示拒绝检测的原因,判断感染HIV的风险大小。方法采用分层整群抽样方法,在31省（自治区、直辖市）333个县对结核病防治机构新登记结核病人开展HIV感染状况调查,在确诊结核病后用知情不拒绝的方式提供HIV检测,用开放式问题收集病人拒绝HIV检测的原因。结果结核病人拒绝HIV抗体检测率为3．3％（1525／45523）。1232例说明了拒绝原因的病人中,5．7％的病人因为“近期做过HIV检测”,14．3％的病人“认为没有必要,无不良行为”,8．4％的病人“健康状况不宜采血”,8．7％的病人“未能到结防机构采血”,4．8％的病人“年纪太小或太大”,54．9％的病人或家属“不同意”或病人“拒绝采血”。拒绝检测者与本次调查发现的HIV阳性者在性别、年龄、职业、民族、文化程度、婚姻状况、居住地、户籍等特征上差异有统计学意义（P〈0．05）。结论拒绝HIV检测的结核病人与HIV阳性病人在各项特征上有较大差别,近半数的病人有合理的拒绝原因、感染HIV风险较低,其余病人拒绝检测的原因和感染风险需要进一步研究。     

Knowledge of HIV Risk Factors Among Immigrants in Thailand

This study is based on a sample of 3,374 immigrants from Cambodia and Myanmar who worked in 17 different provinces in Thailand. Many immigrants workers had not even heard of HIV/AIDS before coming to Thailand, but most have received instruction about HIV/AIDS from some source in Thailand, and a large majority are now aware of HIV/AIDS. While immigrant workers in Thailand are fairly knowledgeable about the risk factors for HIV transmission, important gaps remain. Women, persons with less than five years of education, seafarers, agricultural workers, those who do not personally know anyone affected by HIV/AIDS, and those who have not yet received instruction in HIV/AIDS are the ones most likely to have gaps in their knowledge of HIV/AIDS risk factors.

抗病毒治疗HIV感染者血脂变化轨迹特征及影响因素分析

目的 分析抗病毒治疗HIV感染者血脂变化轨迹特征及其影响因素。方法 基于回顾性队列研究设计,以浙江省台州市2004年1月至2021年4月抗病毒治疗HIV感染者为研究对象,运用χ²检验分析研究对象社会人口学特征和基线指标情况,应用潜在类别混合模型描述研究对象接受抗病毒治疗后血脂变化轨迹,采用多因素logistic回归分析血脂变化轨迹的影响因素。采用R 3.5.0.软件LCMM软件包进行统计学分析。结果 2 079例HIV感染者中,年龄M（Q₁,Q₃）为31（43,55）岁,以男性（78.1%,1 623/2 079）和已婚（58.7%,1 221/2 079）为主,BMI≥24.0 kg/m²占18.9%（393/2 079）,异性性传播途径占67.7%（1 407/2 079）。血脂变化轨迹分为3种：倒U形（2.3%,48/2 079）、进展型（31.3%,650/2 079）和一般轨迹（U形）（66.4%,1 381/2 079）,倒U形和进展型确定为危险轨迹（33.6%）。多因素logistic回归分析结果显示,相比于抗病毒治疗方案为齐多夫定-替诺福韦-依非韦伦（3TC- TDF-EFV）、基线TC水平<5.2 mmol/L、基线TG水平<1.7 mmol/L、BMI为18.5~23.9 kg/m²、基线CD4⁺T淋巴细胞（CD4）计数<200个/μl和抗病毒治疗时间<5年者,抗病毒治疗方案一直使用齐多夫定-拉米夫定-依非韦伦（3TC-AZT-EFV）（aOR=1.99,95%CI：1.44~2.77）和更换为克力芝（LPV/r）（aOR=3.17,95%CI：2.00~5.01）、基线TC水平分别为5.2~6.1 mmol/L（aOR=2.55,95%CI：1.92~3.39）和≥6.2 mmol/L（aOR=5.89,95%CI：3.76~9.25）、基线TG水平分别为1.7~2.2 mmol/L（aOR=2.00,95%CI：1.53~2.62）和≥2.3 mmol/L（aOR=6.51,95%CI：4.97~8.54）、BMI为≥24.0 kg/m²（aOR=1.44,95%CI：1.11~1.88）的HIV感染者较容易出现血脂变化的危险轨迹。而BMI为<18.5 kg/m²（aOR=0.55,95%CI：0.35~0.86）、基线CD4计数为200~349个/μl（aOR=0.67,95%CI：0.52~0.87）和≥350个/μl（aOR=0.71,95%CI：0.54~0.94）、抗病毒治疗时长为5~9年（aOR=0.74,95%CI：0.56~0.99）和≥10年（aOR=0.53,95%CI：0.22~0.67）的HIV感染者较不容易出现血脂变化的危险轨迹。结论 部分HIV感染者抗病毒治疗后的血脂变化呈危险轨迹状态,与AZT和LPV/r等特定抗病毒药物使用、抗病毒治疗时长、基线CD4计数、TC、TG和BMI显著关联,建议HIV感染者开始抗病毒治疗阶段的同时,加强血脂监测并采取针对性干预措施。     

Surveillance or support: The experience of direct observation during tuberculosis treatment

Directly observed therapy (DOT) is a cornerstone of tuberculosis (TB) control. DOT has been criticised as paternalistic, but it has also been argued that the interaction with healthcare workers (HWs) can be a source of support for patients. We explored the experience of patients in antituberculosis treatment, with the aim of understanding the balance between surveillance and support from the recipient’s point of view. We interviewed 27 patients in Tijuana, Mexico, employing narrative analysis to understand how participants made sense of their illness and their experience of DOT. We found a core narrative of biographic disruption and self-reconstruction, in which HWs helped participants to attribute a less negative meaning to TB. Interviewees accepted DOT’s as necessary for other people to avoid treatment abandonment, but felt that in their case it was unnecessary. Only a few felt that DOT represented mistrust on the part of the HWs. We conclude that DOT can be a source of support when it is enacted in a patient-centred way. We discuss whether participants’ lack of criticism of DOT is a case of adaptive preference, in the context of a power differential between patient and health system.     

影响新发涂阳肺结核治疗失败的常见因素分析

目的通过对广州市2003-2007年新发涂阳肺结核治疗病例的分析,找出治疗失败常见因素,为防痨医生治疗患者提供经验借鉴,达到提高治愈率,降低疫情的目的。方法将2003-2007年登记的广州市户籍的新发涂阳肺结核病人的病历资料、服药查痰资料填写统一的《结核病人登记管理卡》,并录入电脑统计。结果 45岁以下患者治疗失败率达4.32%;离退休患者失败率为7.39%,自由职业为6.63%;症状数量5种以上和6个肺野病变的失败率分别为3.80%、5.56%;合并肺外结核、糖尿病、空洞的失败率分别为6.20%、10.69%、4.18%;发现延迟120d的失败率为4.88%;满疗程失败率为2.37%,不满疗程的失败率为10.28%,其中在满疗程规则治疗的失败率为2.31%,不规则治疗的失败率为5.03%;采用2H3R3Z3S3/4H3R3方案和自由组合的其他方案失败率分别为5.48%、5.26%,采用2H3R3Z3E3/4H3R3方案的失败率为0.89%。结论影响新发涂阳肺结核治疗失败的常见因素有很多,除性别外,年龄、职业、症状数量、病变肺野数量、有无空洞、是否合并肺外结核、糖尿病、发现治疗延迟时间、是否全程规则服药、化疗方案是否合理等因素均与治疗失败有关。