在高结核负担的结核病环境中,在艾滋病毒感染者中从结核病预防治疗中长期保护:印度的一项观察性队列研究
Reshu Agarwal1, Melissa Nyendak1, Nalini Chava2
1Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention (CDC), New Delhi, India.
概括
结核病预防治疗 (TPT) 与有效的抗逆转录病毒疗法 (ART) 结合,显著降低了艾滋病毒感染者 (PLWH) 结核病发病率和死亡率. 这种持久的保护对于高负荷设置至关重要.
科学领域:
- 公共卫生 公共卫生
- 传染性疾病 传染性疾病
- 艾滋病毒/艾滋病研究研究
背景情况:
- 结核病预防治疗 (TPT) 是全球结核病终结战略的基石.
- 关于在高结核病负担地区接受抗逆转录病毒疗法 (ART) 的艾滋病毒感染者 (PLWH) 长期使用TPT的长期疗效的数据有限.
研究的目的:
- 评估单次TPT疗程对结核病发病率和死亡率的长期影响.
- 评估TPT完成和有效ART对PLWH结核病和死亡结果的综合影响.
主要方法:
- 一项观察性队列研究跟踪了4706名在印度安得拉邦开始TPT的PLWH,持续了6年.
- 结核病发病率和死亡率计算为每100人/年 (PY).
- 考克斯比例危险模型被用于估计结核病和死亡率的调整危险比率 (aHR),按TPT完成和有效ART (病毒载量<1000副本/毫升) 分层.
主要成果:
- 完成TPT与较低的结核病发病率 (0.55/100 PY) 与未完成 (1.06/100 PY) 相比.
- 在完成TPT (2.2/100 PY) 与未完成 (13.5/100 PY) 之间,全因死亡率明显较低.
- 通过TPT加上有效的ART,结核病风险降低了87% (aHR:0.13) 和全因死亡率降低了94% (aHR:0.06).
结论:
- 一次的TPT疗程,当与有效的ART相结合时,可以在PLWH中对结核病提供持久的保护.
- 这种组合策略在高结核病负担的环境中显著降低了全因死亡率.
- 这些发现支持将TPT和有效的ART整合在一起,以改善PLWH的结果.
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