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| 武汉市HIV/AIDS患者潜伏性结核感染筛查及预防效果 |
| Screening and prevention effect of latent tuberculosis infection in HIV/AIDS patients in Wuhan |
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| DOI：10.3969/j.issn.1007-8134.2021.05.008 |
| 中文关键词: HIV/AIDS 潜伏性结核感染 γ-干扰素释放试验 异烟肼预防治疗 活动性结核病 武汉市 |
| 英文关键词: HIV/AIDS latent tuberculosis infection interferon-gamma release assay isoniazid preventive therapy active tuberculosis Wuhan |
| 基金项目:武汉市公共卫生及卫生政策项目（WG16C10） |
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| 中文摘要: |
| 目的 探讨武汉市HIV/AIDS患者潜伏性结核感染（latent tuberculosis infection, LTBI）筛查的可行性，明确预防治疗存在的问题，为制定适合该人群LTBI筛查及预防流程提供依据。方法 选取2016年1月—2018年12月在武汉市13所HIV/AIDS定点治疗单位随访的2048例HIV/AIDS患者作为研究对象，根据2015版LTBI管理指南筛查流程，筛查LTBI患者并进行6个月异烟肼预防治疗（isoniazid preventive therapy, IPT）。结果 2048例HIV/AIDS患者中，结核病症状调查发现5.2%（107/2048）的患者出现结核病症状，94.8%（1941/2048）的无结核病症状患者进行γ-干扰素释放试验（interferon-gamma release assay, IGRA），IGRA阳性率为21.4%（415/1941）。IGRA阳性者胸片筛查发现，98.1%（407/415）的患者胸片无结核感染表现，诊断为LTBI，约占筛查总人数的19.9%（407/2048）。86.2%（351/407）的LTBI患者接受IPT，其中90.0%（316/351）的患者完成了6个月IPT，随访至12个月后，发现IPT组有1.7%（6/351）进展为活动性结核病（active tuberculosis, ATB），非IPT组有8.9%（5/56）进展为ATB，2组比较差异有统计学意义（χ2=8.170，P=0.004）。结论 在武汉市HIV/AIDS患者中，LTBI发生率约为19.9%，IPT可以降低HIV/AIDS患者LTBI进展为ATB的风险，且不良反应少，但接受IPT比例和治疗完成率偏低，须建立督导机制，以提高IPT的接受率和完成率。 |
| 英文摘要: |
| Objective To explore the feasibility of latent tuberculosis infection (LTBI) screening and clarify the existing problems in prevention and treatment of HIV/AIDS patients in Wuhan, to provide the basis for formulating LTBI screening and prevention process applicable for such patients. Methods A total of 2048 HIV/AIDS patients who were followed up in 13 HIV/AIDS designated treatment units in Wuhan from January 2016 to December 2018 were selected as research subjects. According to the screening process of WHO Guidelines on Management of Latent Tuberculosis Infection (2015 edition), the LTBI patients were screened and treated with isoniazid preventive therapy (IPT) for 6 months. Results In 2048 HIV/AIDS patients, 5.2% (107/2048) of patients were found to have symptoms of tuberculosis by the tuberculosis symptom survey. The remaining 94.8% (1941/2048) of patients without tuberculosis symptoms were subject to interferon gamma release assay (IGRA), and IGRA positive rate was 21.4% (415/1941). In the IGRA positive patients screened by chest X-ray, 98.1% (407/415) of patients had no tuberculosis infection manifestation and were diagnosed as LTBI, and the LTBI patients accounted for 19.9% (407/2048) of the total number of screened patients. 86.2% (351/407) of LTBI patients received IPT, of which 90.0% (316/351) completed IPT for 6 months. At the follow-up of the 12th month, 1.7% (6/351) in the IPT group and 8.9% (5/56) in the non-IPT group progressed to active tuberculosis, and the difference between 2 groups was statistically significant (χ2=8.170, P=0.004). Conclusions The prevalence of LTBI among HIV/AIDS patients in Wuhan is about 19.9%. IPT can reduce the risk of HIV/AIDS patients merging LTBI into active tuberculosis, with less adverse reactions. However, the acceptance rate and completion rate of IPT are relatively low. It is necessary to establish a supervision mechanism to improve the acceptance rate and completion rate of IPT. |
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