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背景:艾滋病病毒(HIV)感染会导致结核分枝杆菌潜伏感染的复燃或近期(再次)感染结核分枝杆菌后发展成为活动性结核病。尽管发病既往有结核分枝杆菌潜伏感染的证据,但如果发生在同一时期的结核病患者的结核分枝杆菌菌株相同(例如“组群病例”),则本次发病很可能是由于近期(再次)感染结核分枝杆菌所致。方法:在马拉维北部卡朗加区1996年至2008年间曾第一次患结核病的患者中,若其具有1990年之前结核分枝杆菌潜伏感染状态(结核分枝杆菌素皮肤试验)的信息和结核病发病时的DNA指纹结果,则纳入本研究。我们对既往结核分枝杆菌潜伏感染状况和HIV感染状况进行分组,探讨组间的差异,并依据年龄、性别、卡介苗疤痕状况和距结核分枝杆菌素检测的时间作了调整。结果:在79例HIV阴性的结核病患者中,有结核分枝杆菌潜伏感染史的患者比无结核分枝杆菌潜伏感染史的患者更少发生组群病例(29比77%,调整OR=0.15,95%可信区间为0.04～0.59)。在119个HIV阳性结核病患者中,两组的组群病例所占比例相似(88%比84%,调整OR=1.85,95%可信区间为0.41～8.29)。讨论:HIV感染似乎增加了新近再次感染结核分枝杆菌而发展成为结核病的风险。越来越多证据表明HIV相关结核病主要源于新近结核分枝杆菌感染,我们的研究结果也证实了这一点。
Background: HIV infection leads to the reactivation of latent infection with M. tuberculosis or the development of active tuberculosis after (re) infection with M. tuberculosis. In spite of the evidence of latent infection with M. tuberculosis in the past, if the M. tuberculosis strains of tuberculosis patients in the same period are the same (eg, “cohort”), the incidence is most likely due to the recent ( Again) due to Mycobacterium tuberculosis infection. METHODS: Of the patients with TB who were the first to experience tuberculosis between 1996 and 2008 in the Karanga district of northern Malawi, if they had information on the latent infection status of M. tuberculosis (tuberculous mycobacterial skin test) prior to 1990 And DNA fingerprinting at the onset of tuberculosis were included in this study. We grouped the past latent tuberculosis and HIV status of tuberculosis and investigated the differences between the groups and adjusted for age, sex, BCG scar status, and timing of tuberculous mycobacterium tuberculosis testing. RESULTS: Of the 79 HIV-negative TB patients, those with a history of latent infection with M. tuberculosis developed fewer cohorts than patients without a history of latent TB infection (29 vs. 77%, OR = 0.15, 95% confidence interval 0.04 ~ 0.59). Among 119 HIV-positive TB patients, the two groups had similar proportions of cohorts (88% vs 84%, adjusted OR = 1.85, 95% confidence interval, 0.41 to 8.29). Discussion: HIV infection appears to increase the risk of developing tuberculosis again with newly infected Mycobacterium tuberculosis. There is growing evidence that HIV-related TB is mainly due to recent Mycobacterium tuberculosis infection, as our findings confirm.