HIV(+)/AIDS病人合并结核(TB)感染的研究进展

HIV( )/AIDS病人由于细胞免疫功能低下,CD4 T淋巴细胞数降低,常合并各种感染,尤以合并TB感染最为常见,本文对HIV( )/AIDS病人合并TB感染的现状、相互影响机制、合并感染的方式和临床特点、组织病理学、诊断、预防、预防性化疗、治疗原则以及抗病毒治疗药物和抗结核药物之间的相互作用进行了综述,大量的研究证明,HIV( )/AIDS病人合并TB感染,两者相互影响,互相促进,加快疾病的进程.早发现、早诊断,早治疗、早预防双重感染,可极大的改善患者的生存条件和延长寿命,对预防和控制艾滋病和结核病的快速流行具有极其重要的意义.     

结核杆菌／艾滋病病毒双重感染流行病学研究现况

结核病（TB）已成为HIV／AIDS最常见的机会性感染性疾病,也是HIV／AIDS最常见的死亡原因,而HIV则是已知的、增加TB危险性最重要的因素。HIV与MTB感染相互影响、相互促进。近年全球HIV合并TB病例呈逐年上升趋势。在HIV感染者／AIDS患者中可采取液体培养、Y干扰素释放试验等快速诊断试验来筛查TB患者。TB／HIV双重感染防治策略强调的是加强结核与艾滋病两防治机构的密切合作,同时开展监测和治疗管理工作。     

TB/HIV双重感染诊断治疗专家组合作机制现状与影响因素分析

目的定性调查基层结核杆菌/艾滋病病毒（TB/HIV）双重感染诊断治疗专家组合作机制及其影响因素,为制定国家TB/HIV双重感染合作机制提供科学依据。方法选择已经开展TB/HIV双重感染的3县（区）,使用观察法和关键知情人深入访谈的方法,了解TB/HIV双重感染防治合作现状和影响因素。结果成立TB/HIV双重感染诊断治疗专家组是十分必要的,且需要建立由结核病专家和艾滋病专家组成的诊断治疗专家组;三县为开展TB/HIV双重感染工作,初步建立了疾病预防控制机构或传染病专科医院为中心的会诊模式;会诊中以HIV/AIDS中结核病的诊断和治疗方案为主。但是领导重视程度和协调机制、专家诊断治疗水平、医疗机构参与、医生态度和投入的时间等因素仍然是导致诊疗延误的重要因素。结论建立结核病/艾滋病双重感染诊断治疗专家组,是结核病/艾滋病防治合作机制的重要内容。通过加强领导重视和制度建设;加强疾病预防控制机构和医疗机构间的协调力度;医患双方的宣传教育健全合作机制,避免和减少延迟诊治。     

云南省TB/HIV双重感染患者抗结核治疗死亡危险因素生存分析

目的 分析结核分枝杆菌/艾滋病病毒双重感染患者（mycobacterium tuberculosis and human immunodeficiency virus co-infection patients,TB/HIV）抗结核治疗期间死亡相关影响因素。方法 运用1:1配对设计的队列研究方法对TB/HIV双感染患者与普通结核患者接受标准化抗结核治疗期间死亡率差异进行比较,并对TB/HIV双感染患者进行死亡危险因素分析。结果 TB/HIV双感染患者死亡率为6.60%,普通结核患者死亡率为0.43%。对TB/HIV双感染患者进行Cox回归分析,患者病情程度、就诊延迟时间及CD4+T淋巴细胞水平是造成TB/HIV双感染患者死亡的主要影响因素（均有P<0.05）。其中,重症患者出现死亡的风险是非重症患者的2.049倍,就诊延迟≥14 d患者出现死亡的风险是就诊延迟<14 d的1.521倍,CD4+T淋巴细胞<50个/μl是≥50个/μl的2.943倍。抗病毒治疗开始时间及是否接受抗病毒治疗也是造成双感染患者死亡的影响因素。结论 通过筛查尽早发现并及时予以标准化的抗结核治疗。根据患者自身情况,对符合条件者尽早开始抗病毒治疗,提高患者的生存率,降低死亡风险。     

安徽省艾滋病病毒感染者／艾滋病患者肺结核年发病率研究

艾滋病和结核病均为目前全球严重的公共卫生问题，两者相互影响，流行日趋严重，尤其是当HIV与TB双重感染时，结核病即成为HIV感染者的头号杀手。为了解我省艾滋病病毒感染者／艾滋病患者肺结核病的发病情况，我们于2005年4月至2006年8月，在我省HIV感染较为严重的2县随机选取了150例艾滋病病毒感染者／艾滋病患者观察1年，以了解其肺结核发病情况，为我省制订控制HIV／MTB双重感染的政策提供依据。     

在押人群HIV/AIDS与结核病双重感染调查

目的调查在押人群的人类免疫缺陷病毒（HIV）感染与合并结核病（TB）双重感染情况.方法对2005年6月～9月某监所860名在押人群进行HIV检测,并调查结核病感染情况及吸毒史.结果 860名在押人群中HIV感染者50例,占5.8%;50例HIV感染者中结核病11例,发病率22%;810例HIV阴性者中结核病8例,发病率0.99%.HIV感染者结核病的发病机率远远大于HIV阴性者,二者比较差异有统计学意义（P〈0.05）.结论在押人群中HIV阳性者合并TB的机率高于HIV阴性者,建议对HIV阳性者应进行常规痰涂片检查和结核菌素试验,以期做到艾滋病（AIDS）合并结核病（TB）的早期诊断与治疗.     

文山市37例TB／HIV双重感染病人流行病学分析

目的通过分析文山市结核病与艾滋病双重感染病人流行状况，为今后做好TB／HIV双重感染病人防控管理工作提供科学依据。方法对文山市2010---2012年发现的37例TB／HIV双重感染病人性别、年龄、职业、感染途径等进行分析。结果综合感染阳性率为1．80％；以男性为主；年龄以35～44岁组为多，占48．65％；职业以农民为主，占48．65％；途径以异性传播为主；未进行抗病毒治疗和未接受复方新诺明预防性服药病人的死亡率均明显高于治疗和服预防性药物者。结论文山市开展TB／HIV双重感染病人筛查具有重要现实意义，并应依据流行病学特征及时做好TB／HIV双重感染病人防控工作。     

艾滋病母婴阻断效果分析

目的及时掌握预防艾滋病母婴传播工作效果。方法对防城区2011-2012年有妊娠结局的34例HIV感染的孕产妇及所生的婴儿进行回顾性分析．满18月龄的儿童为15例,中其有3例儿童死亡,2例失访。结果儿童死亡率33．79％,现存活的满18月的儿童为10例,其中1例为18月龄确证为HIV阳性,9例为HIV阴性,儿童HIV阳性感染率为10％,阴性率为90％。结论对在孕期或产时HIV感染的孕产妇及所生的婴儿实施预防性抗病毒药物应用后,发生儿童死亡及儿童HIV感染的机会减少,可明显降低母婴传播风险;反之,HIV染的孕产妇和其所生的婴儿在围生期未使用抗病毒药物治疗,未选择剖宫产分娩,HIV感染母亲所生儿童的死亡率会增加,增加了儿童感染HIV的机会。现行的预防艾滋病母婴传播措施是有效的     

2005～2011年济源市TB／HIV双重感染者资料分析

[目的]了解济源市结核病合并艾滋病（TB／HIV双重感染）者情况,为制定TB／HIV双重感染防治措施提供科学依据。[方法]对济源市2005～2011年发现的TB／HIV双重感染者资料进行分析。[结果]2005～2011年3650例结核病病人中,合计检测艾滋病病毒（HIV）抗体3215例,检出HIV抗体阳性的15例,阳性率为0．47％;检测95例HIV感染者／艾滋病（AIDS）病人,检出5例结核病病人,阳性率为5．26％。20例双重感染者中,男性18例,女性2例;Ⅱ型结核11例,Ⅲ型结核8例,Ⅳ型1例;痰涂片阳性16例,阴性4例;HIV的传播途径,血液传播14例,性传播6例;16例涂阳肺结核患者经6～12个月正规抗痨治疗,治愈14例,1例死亡,治愈患者中1例1年后复发,再次治疗月余死亡,失败1例;4例涂阴全部完成疗程;10例进行抗HIV治疗。[结论]结核病和艾滋病的双向筛查策略是预防和控制TB／HIV双重感染流行的有效途径和方法。     

恩施州全球基金TB／HIV双重感染防治项目实施效果评价

目的分析和评价恩施州第5轮全球基金结核杆菌／人类免疫缺陷病毒（TB／HIV）双重感染防治项目实施结果,为制定恩施州TB／HIV双重感染防治工作框架提供理论依据。方法对项目执行期间的报表、项目督导和工作考核等资料进行统计分析。结果恩施州实施第5轮全球基金项目落实经费165．43万元;对5391例结核病患者开展了AIDS（艾滋病）咨询检测,HIV抗体阳性检出率0．29％;对存活的241例人类免疫缺陷病毒（感染者）／艾滋病（患者）（HIV／AIDS）开展了TB筛查,TB检出率2．14％;对发现的39例TB／HIV双重感染患者全部实施了抗TB和复方新诺明（CPT）预防性治疗,对18例符合抗病毒治疗条件的患者进行抗病毒治疗。结论通过实施第5轮全球基金项目TB／HIV双重感染防治工作,应用科学、系统的控制策略和技术,掌握了该州项目地区的TB／HIV双重感染的现状,并采取了相应的防控对策。     

HIV-TB co-infection in children: associated factors and access to HIV services in Lagos,Nigeria

Background: Human immunodeficiency virus (HIV) and tuberculosis (TB) are the leading causes of death from infectious disease worldwide. The World Health Organization estimates that the prevalence of HIV among children with TB in moderate to high prevalence countries ranges between 10% and 60%. This study aimed to determine the access to HIV services of HIV-TB co-infected children.Methods: A retrospective review of data of children diagnosed with TB in Lagos State, Nigeria from 1 January 2012 to 31 December 2013.Results: A total of 1199 children aged between 0 and 14 years were diagnosed with TB. Of 1095 (91.3%) who underwent testing for HIV, 320 (29.2%) were HIV seropositive. The male-to-female ratio of HIV-TB positive outcomes was 1:0.9. Of the 320 HIV-TB co-infected children, 57 (17.8%) were aged <1 year, 86 (26.9%) 1–4 years and 186 (58.1%) 5–14 years; 186/320 (58.1%) began cotrimoxazole preventive therapy (CPT), and 151 (47.2%) were put on antiretroviral treatment (ART). ART uptake was not significantly higher in facilities where HIV-TB services were co-located (P > 0.05).Conclusion: The uptake of CPT and ART was low. There is a need to intensify efforts to improve access to HIV services in Lagos State, Nigeria.     

Severity of Outcomes Associated to Types of HIV Coinfection with TB and Malaria in a Setting Where the Three Pandemics Overlap

The objectives of this study is to (1) characterize profiles of HIV coinfection with TB and malaria; (2) estimate the severity of outcome associated with each type of coinfection; (3) identify most severe coinfection type, and populations most affected. Data on 1,302 HIV/AIDS patients were collected from hospital record books for 2007 and 2008. Distribution patterns of types of HIV coinfection with TB and malaria were assessed among low and high SES (socioeconomic status) inpatients. Case fatality rate for each type of coinfection was estimated as the ratio of number of deaths associated with a specific type of coinfection over the number of cases, times 100. Case fatality rates were compared among coinfection types and between low and high SES inpatients. Four types of coinfections were identified: single-HIV, HIV-TB, HIV-malaria and HIV-TB-malaria. Single-HIV infection was the most prevalent, and predominant among high SES inpatients; HIV-TB was the second most prevalent, and predominant among low SES inpatients; HIV-malaria and HIV-TB-malaria coinfections were the least prevalent, they were relatively comparable between both SES groups. HIV-TB coinfection was the deadliest type of coinfection, followed by HIV-TB-malaria and HIV-malaria. Single-HIV infection was the least deadly of the four conditions. Aside from HIV-malaria, the proportion of fatalities associated with each coinfection type was higher among low SES inpatients when compared with high SES inpatients. HIV/AIDS treatment and care programs in communities with limited resources and high prevalence of malaria and TB should give priority attention to low socioeconomic status patients coinfected with TB to prevent unnecessary deaths among those living with HIV.     

山东省结核病人中HIV感染率调查资料的流行病学特征分析

[目的]了解山东省结核病人中的HIV感染率基线情况并着重对不同性别TB/HIV感染者的流行病学特征进行分析,为降低HIV感染人群中结核病的负担提供基础数据。[方法]采用系统抽样方法抽取14个县作为调查点,对调查点2007年9月1日至12月31日期间新登记的结核病人进行HIV抗体筛检工作。[结果]项目期间共纳入有效病人1881例,进行HIV抗体初筛1794例,受检率为95.37% 检测出TB/HIV双重感染者2例,检出率为1.11‰ 不同性别结核病人的年龄、学历、婚姻状况分布不同 检出的2例TB/HIV双重感染者具备主动实施的高危行为史。[结论]山东省结核病人中的HIV感染率较低 在HIV低流行地区的结核病人中开展常规HIV抗体的普遍筛检不符合成本效益原则 对具有高危行为的结核病人进行选择性HIV抗体检测尤为重要。     

Barriers for introducing HIV testing among tuberculosis patients in Jogjakarta,Indonesia: a qualitative study

Background  

HIV and HIV-TB co-infection are slowly increasing in Indonesia. WHO recommends HIV testing among TB patients as a key response to the dual HIV-TB epidemic. Concerns over potential negative impacts to TB control and lack of operational clarity have hindered progress. We investigated the barriers and opportunities for introducing HIV testing perceived by TB patients and providers in Jogjakarta, Indonesia.     

Barriers and facilitators of adherence to TB treatment in patients on concomitant TB and HIV treatment: a qualitative study

Background  

Tuberculosis is a major public health problem in Ethiopia, and a high number of TB patients are co-infected with HIV. There is a need for more knowledge about factors influencing treatment adherence in co-infected patients on concomitant treatment. The aim of the present study is to explore patients' and health care professionals' views about barriers and facilitators to TB treatment adherence in TB/HIV co-infected patients on concomitant treatment for TB and HIV.     

Emergence of Increased Resistance and Extensively Drug-Resistant Tuberculosis Despite Treatment Adherence, South Africa

We investigated the emergence and evolution of drug-resistant tuberculosis (TB) in an HIV co-infected population at a South African gold mine with a well-functioning TB control program. Of 128 patients with drug-resistant TB diagnosed during January 2003–November 2005, a total of 77 had multidrug-resistant (MDR) TB, 26 had pre–extensively drug-resistant TB (XDR TB), and 5 had XDR TB. Genotyping suggested ongoing transmission of drug-resistant TB, and contact tracing among case-patients in the largest cluster demonstrated multiple possible points of contact. Phylogenetic analysis demonstrated stepwise evolution of drug resistance, despite stringent treatment adherence. These findings suggested that existing TB control measures were inadequate to control the spread of drug-resistant TB in this HIV co-infected population. Diagnosis delay and inappropriate therapy facilitated disease transmission and drug-resistance. These data call for improved infection control measures, implementation of rapid diagnostics, enhanced active screening strategies, and pharmacokinetic studies to determine optimal dosages and treatment regimens.     

安徽省某市结核病人中HIV感染状况分析

目的了解安徽省某市结核病人中HIV感染情况,为制定结核病和艾滋病双重感染防治对策提供科学依据。方法对新登记人项的1212例结核病人用酶联免疫法进行HIV初筛试验,初筛阳性者进行免疫印迹法确认试验进行确认,并进行流行病学调查。结果1212例结核病人检出HIV感染者4例（其中死亡1例）,感染率为0．33％,其中健在的3例中,2例男性,1例女性;民工2例,农民1例,平均年龄为（34．00±10．44）岁,传播途径均为性传播。结论结核病人中HIV感染率高于一般人群,应在结核病人群中加强艾滋病的宣传教育和行为干预。     

Integration of tuberculosis and HIV services: Exploring the perspectives of co-infected patients in Ghana

Scaling up of integrated tuberculosis (TB)–human immunodeficiency virus (HIV) services remains sub-optimal in many resource-limited countries, including Ghana, where the two conditions take a heavy toll on the financial resources of health systems as well as infected persons. Previous studies have documented several implementation challenges towards TB–HIV service integration, but views of patients on integrated service delivery have not received commensurate research attention. This paper explored the experiences of 40 TB–HIV co-infected patients at different stages of treatment in Ghana. Using Normalisation Process Theory as a framework, data were coded using inter-rater coding technique and analysed inductively and deductively with the help of QSR NVivo 10. For several participants, either of the diseases was diagnosed ‘accidentally’, leading to inconsistencies in co-therapy administration, constraints regarding separate clinic appointment dates for TB and HIV and prolonged TB treatment due to treatment failure. Put differently, there were widespread negative experiences among TB–HIV co-infected patients with regard to treatment and care, especially among patients who were accessing care in separate facilities or separate units in the same facility. Co-infected patients unanimously support full-service integration. However, they felt powerless to request for reforms on a mode of service delivery.     

Tuberculosis incidence and the seroprevalence of HIV infection in the United States.

Unlike other available studies, this article not only recognizes a human immunodeficiency virus-tuberculosis (HIV-TB) correlation but also shows its strength, statistical significance, and the method of calculation. These results increase comparability of the data on the HIV-TB relationship and allow more accurate analysis for developing better control of the two diseases. This population-based study compares data by states on HIV seroprevalence among 1,799,771 military recruits and the incidence of TB in the general population of the United States in 1987. The corresponding correlation coefficient was 0.8 (P less than .001). Although military recruits do not constitute a random sampling of the population at risk for TB, the high correlation suggests that HIV infection contributes substantially to population-based rates of TB.