HIV感染者に対する結核予防プログラムにおける胸部放射線検査の価値,ボツワナ,ボツワナ
B Mosimaneotsile1, E A Talbot, T L Moeti
1BOTUSA Project, US Centers for Disease Control and Prevention, Gaborone, Botswana. baru1@cdc.gov
Lancet (London, England)
|November 15, 2003
まとめ
無症状のHIV感染者が結核予防を始める場合,通常の胸部放射線は不要です. 胸部X線検査は,この研究で結核の診断がほとんどなかったため,症状のスクリーニングは十分です.
科学分野:
- 感染症 感染症は感染症です.
- 公衆衛生は公衆衛生である.
- HIV/AIDSの管理について
背景:
- 結核 (TB) の予防は,HIV感染者に対して推奨されています.
- 世界保健機関 (WHO) /UNAIDSのガイドラインは,結核予防を開始する前に,病歴,症状のスクリーニング,胸部放射線撮影を推奨しています.
- この特定の文脈における通常の胸部X線写真の有用性は不明である.
研究 の 目的:
- イソニアジドによる予防治療を開始する前に,無症状のHIV感染者に対して結核のスクリーニングを行うために,胸部X線写真の価値を評価する.
主な方法:
- イソニアジドによる予防治療を求めるHIV感染者935人の外科医を対象とした前向きな研究.
- 患者は症状のスクリーニングを受けた.
- 胸部放射線撮影を行い,その後,結核の診断を分析した.
主要な成果:
- 935人の患者のうち,692人 (74%) が結核の無症状であった.
- 無症状患者のうち,123人 (18%) が,X線写真の過程でフォローアップを怠った.
- 残りの563人の無症状患者のうち,1人の患者 (0.2%) だけが,胸部X線写真に基づいて結核と診断されました.
結論:
- 無症状のHIV感染者が,効果的な症状スクリーニングを行う環境で,イソニアジドによる予防療法を開始する場合,通常の胸部放射線検査は推奨されません.
- 症状のスクリーニングだけでは,この集団で活性結核を特定するのに十分なようです.
- このアプローチは,結核予防のイニシアチブを合理化し,医療資源の利用量を減らすことができます.
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