艾滋病病毒与结核分枝杆菌双重感染对死亡的影响

郑志刚; 耿文奎; 陆珍珍; 李剑军; 周崇兴; 杨文敏

Abstract

郑志刚,耿文奎,陆珍珍,李剑军,周崇兴,杨文敏.艾滋病病毒与结核分枝杆菌双重感染对死亡的影响[J].Chinese journal of Epidemiology,2018,39(10):1362-1367

艾滋病病毒与结核分枝杆菌双重感染对死亡的影响

Impact of HIV and Mycobacterium tuberculosis co-infection on related mortality

Received:March 05, 2018

DOI：10.3760/cma.j.issn.0254-6450.2018.10.014

KeyWord: 艾滋病病毒结核分枝杆菌双重感染特征

English Key Word: HIV Mycobacterium tuberculosis Co-infection Characteristics

FundProject:国家自然科学基金（81760618）；广西医疗卫生适宜技术推广与应用项目（S201682）；广西壮族自治区卫生和计划生育委员会自筹经费科研课题（Z2016451）

Author Name	Affiliation	E-mail
Zheng Zhigang	Department of AIDS Control and Prevention, Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning 530028, China
Geng Wenkui	Special Office of AIDS Prevention and Treatment, Guangxi Zhuang Autonomous Region Commission of Health and Family Planning, Nanning 530021, China
Lu Zhenzhen	Department of AIDS Control and Prevention, Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning 530028, China
Li Jianjun	Department of AIDS Control and Prevention, Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning 530028, China
Zhou Chongxing	Department of AIDS Control and Prevention, Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning 530028, China
Yang Wenmin	General Affairs Offices, Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning 530028, China	ywm5839@163.com

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Abstract:

目的了解广西壮族自治区（广西）HIV及结核分枝杆菌（Mycobacterium tuberculosis，MTB）双重感染对死亡的影响，为有效控制HIV/MTB双重感染提供依据。方法利用中国疾病预防控制信息系统的艾滋病综合防治信息系统和结核病防治数据系统，收集整理2011年广西HIV/MTB双重感染患者，采用跨系统和大数据串联分析方法，交叉核对艾滋病治疗、随访、综合信息以及结核病患者登记报告基本信息，明确HIV/MTB双重感染患者；用描述性流行病学方法、χ²检验以及Cox比例风险回归模型描述、分析资料。结果 HIV感染者及艾滋病患者登记队列（HIV/AIDS队列）感染MTB比例为17.72%（2 533/14 293）；结核病患者登记队列（结核病队列）感染HIV比例5.57%（2 351/42 205）；随访1年内HIV/AIDS队列发现的HIV/MTB双重感染患者病死率为15.16%（384/2 533），高于单纯感染HIV者随访1年的病死率（13.63%，1 603/11 760）（P<0.000 1）；19.33%（384/1 987）当年登记、当年死亡的HIV/AIDS由感染MTB引起。HIV/AIDS队列和结核病队列发现的双重感染分别有60.05%（1 521/2 533）、47.90%（1 126/2 351）开始抗病毒治疗；HIV/AIDS队列发现的结核病患者结核病治愈率为15.48%（392/2 533），完成疗程比例为27.48%（696/2 533）；结核病队列发现的HIV/AIDS其结核病治愈率为19.70%（463/2 351），完成疗程比例为37.26%（876/2 351）；64.13%（785/1 224）HIV/MTB双重感染报告时CD4⁺T淋巴细胞计数（CD4）<200个/μl。与单纯感染HIV者相比，HIV/MTB双重感染患者5年死亡风险增高1.17倍，和单纯感染MTB者相比，HIV/MTB双重感染者12个月死亡风险增加25.68倍。结论广西HIV/MTB双重感染死亡、发病占报告艾滋病患者比例较高，病死率及死亡风险明显高于单纯感染HIV者及单纯感染MTB者；应该尽快提高抗病毒治疗覆盖率和抗结核治愈率；针对HIV感染者，应加强早发现和早治疗MTB感染。

English Abstract:

Objective To understand the impact of HIV and Mycobacterium tuberculosis (MTB) co-infectious (HIV/MTB) on related mortality in Guangxi Zhuang Autonomous Region, provide evidence for the development of a better HIV/MTB co-infection control and prevention program. Methods A multiple cross-systems check (MCSC) approach was used to confirm the HIV/MTB co-infection individuals on data related to treatment, follow-up, epidemiological comprehensive and Tuberculosis (TB) special report system. Social demography characteristics, incidence of TB among HIV positive individuals, HIV incidence among MTB infection persons etc., were described. We compared the mortalities and related risks between HIV/MTB co-infection and mono HIV positive individuals as well as between the HIV/MTB co-infection and mono MTB infection persons, using both the Chi Square test and the Cox's proportional hazard regression model (Cox). Results Reported data showed that the incidence of MTB co-infection in the HIV cohort was 17.72% (2 533/14 293), while HIV incidence in the TB patients was 5.57% (2 351/42 205), respectively. The mortality of HIV/MTB co-infection in the HIV/AIDS cohort was 15.16% (384/2 533) within one-year of observation and was significantly higher than the mortality (13.63%,1 603/11 760) of mono HIV positive individuals (P<0.000 1). The percentage of the HIV/AIDS death cases was 19.33% (384/1 987) who registered and died in the 2011 calendar year were caused by MTB co-infection. Among all the HIV/MTB co-infection patients who had been identified from the HIV cohort, 60.05% (1 521/2 533) had initiated ART, 15.48% (392/2 533) had been cured for TB and 27.48% (696/2 533) had been under complete TB regimen. Among the confirmed HIV/MTB cases from the TB cohort, the cure rate of TB was 19.70% (463/2 351) and the percentage of completed TB regimen was 37.26% (876/2 351). The percentage of the individuals whose CD4⁺ T lymphocyte cells count appeared less than 200 cell/μl was 64.13% (785/1 224), upon the HIV diagnoses were made. Compared with individuals who were under mono HIV infection, the mortality risk on HIV/MTB co-infection was 1.17 times higher during the five-year observation period, then the patients with only mono MTB infection and the mortality risk in patients with HIV/MTB co-infection was 25.68 times higher under the 12-month observation period. Conclusions Both the incidence and mortality of HIV/MTB appeared high in Guangxi, with mortality and the risk of mortality in the HIV/MTB co-infection group significantly higher than that in both the HIV mono infection and the MTB mono infections groups. Both the rate of antiretroviral treatment coverage and the cure rate of TB treatment should be increased in no time as well as the capability of early TB case-finding among people living with HIV.

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