2017—2019年长沙地区HIV感染者/AIDS患者合并肺结核感染的流行现状及相关危险因素

Prevalence and risk factors of AIDS/HIV patients complicated with pulmonary tuberculosis in Changsha area from 2017 to 2019

目的探讨长沙地区艾滋病(HIV)感染者/人类免疫缺陷病毒(AIDS)患者合并肺结核感染的流行现状及相关危险因素。方法选择2017年1月—2019年10月长沙地区艾滋病治疗定点医院接受抗病毒治疗的1328例HIV感染者/AIDS患者进行回顾性队列分析。收集患者人口学与临床资料,根据有无合并结核感染将其分为2组,合并结核杆菌感染的273例(20.56%)为观察组,其余1055例为对照组开展队列分析研究。结果患者性别、年龄、居住地、职业、吸毒史、吸烟史、临床分期及基线CD4值、卡介苗接种史、商业性行为安全套使用情况、其他机会感染发生情况、估计HIV感染者/AIDS患者感染病程的不同,HIV感染者/AIDS患者合并肺结核感染的发生情况差异均有统计学意义(均P<0.05)。多因素logistic回归分析显示,年龄30~45岁(OR=1.594,95%CI=1.193~1.985)、居住地为农村(OR=1.711,95%CI=1.285~2.490)、自由职业或无业(OR=1.612,95%CI=1.205~1.883)、有吸毒史(OR=1.653,95%CI=1.144~1.960)、WHO临床分期Ⅲ期(OR=1.412,95%CI=1.174~1.728)、Ⅳ期(OR=1.810,95%CI=1.402~2.599),基线CD 4值>200个/mm3(OR=2.213,95%CI=1.643~2.980)、商业性行为时每次均不用/偶尔不用安全套(OR=2.358,95%CI=1.647~2.791)、发生其他机会感染(OR=2.418,95%CI=1.839~3.157)、估计HIV感染病程≥5年(OR=2.379,95%CI=1.697~2.993)为长沙地区HIV感染者/AIDS患者合并结核感染的危险因素。女性(OR=0.593,95%CI=0.218~0.760)、年龄≥60岁(OR=0.579,95%CI=0.241~0.778)、接种卡介苗(OR=0.614,95%CI=0.226~0.893)均为保护因素(均P<0.05)。结论长沙地区HIV感染者/AIDS患者合并肺结核主要与患者年龄、性别、居住地、职业、吸毒史、临床分期、基线CD4值、卡介苗接种史、商业性行为安全套使用、机会感染、HIV感染病程等因素有关,临床上对HIV感染者/AIDS患者治疗时应注意以上因素的影响,采取有效方式干预以降低合并感染率。

Objective To explore the prevalence status and related risk factors of HIV/AIDS patients complicated with pulmonary tuberculosis in Changsha area.Methods A retrospective cohort analysis was performed on 1328 HIV/AIDS patients who received antiviral treatment at designated AIDS treatment hospitals in Changsha area from January 2017 to October 2019.The demographic and clinical data of patients were collected.The HIV/AIDS patients were divided into two groups based on the presence or absence of combined tuberculosis infection,273 patients(20.56%)with tuberculosis infection were the observation group,and the remaining 1055 patients were the control group,to conduct the cohort study.Results There were statistically significant differences in the incidence of HIV/AIDS combined tuberculosis infection among different groups in gender,age,place of residence,occupation,drug use history,smoking history,clinical stage and baseline CD4 value,BCG vaccination history,condom use in commercial sexual behavior,occurrence of other opportunistic infections,and estimation of the course of HIV/AIDS infection(all P<0.05).Multivariate logistic regression analysis results showed that age of 30-45 years old(OR=1.594,95%CI=1.193-1.985),the residence in the countryside(OR=1.711,95%CI=1.285-2.490),self employed or unemployed(OR=1.612,95%CI=1.205-1.883),history of drug abuse(OR=1.653,95%CI=1.144-1.960),WHO clinical stage III(OR=1.412,95%CI=1.174-1.728),stageⅣ(OR=1.810,95%CI=1.402-2.599),baseline CD4 value>200/mm^3(OR=2.213,95%CI=1.643-2.980),no/occasionally using condom during commercial sex(OR=2.358,95%CI=1.647-2.791),having other opportunistic infections(OR=2.418,95%CI=1.839-3.157),and the estimated duration of HIV infection≥5 years(OR=2.379,95%CI=1.697-2.993)were the risk factors for AIDS/HIV combined infection in Changsha area.Female(OR=0.593,95%CI=0.218-0.760),age≥60 years old(OR=0.579,95%CI=0.241-0.778),BCG vaccination(OR=0.614,95%CI=0.226-0.893)were protective factors(P<0.05).Conclusion HIV/AIDS patients complicated with pulmonary tuberculosis in Changsha area is mainly related to age,gender,place of residence,occupation,drug use history,clinical stage,baseline CD4 value,BCG vaccination history,condom use in commercial sexual behavior,opportunistic infection,HIV infection course and other factors.In clinical treatment of HIV/AIDS patients,it is necessary to pay attention to the above factors and take effective measures to reduce the co-infection rate.