HIV/AIDS合并结核分枝杆菌潜伏感染特征及影响因素分析

Characteristics and influencing factors of latent infection of HIV/AIDS complicated with Mycobacterium tuberculosis

目的探讨HIV/AIDS患者结核分枝杆菌潜伏感染状况及影响因素,为开展结核病潜伏感染预防性干预提供依据。方法以2020年1月—2021年3月南宁市第四人民医院确证为HIV感染且未患结核的患者为研究对象,进行γ-干扰素释放试验,以结核分枝杆菌潜伏感染(LTBI)者为观察组,单纯HIV/AIDS患者为对照组,调查流行病学特征并对潜伏感染的可能影响因素,如性别、年龄、民族、居住地、BMI、家庭人均月收入、基础性疾病、结核病密切接触史、卡介苗接种史、CD4^(+)T淋巴细胞、HIV感染病程、合并机会性感染等12项按α=0.10的水准进行单因素筛选,将单因素分析结果纳入Logistic回归分析,探讨HIV/AIDS患者结核分枝杆菌潜伏感染影响因素。结果650例HIV/AIDS患者中发现LTBI 112例,检出率17.23%。将单因素分析有统计学意义的6个因素纳入多因素Logistic回归分析,最终进入回归模型的因素为CD4^(+)T淋巴细胞、结核病密切接触史、HIV感染病程、合并其他机会性感染,其调整的OR值及OR95%CI分别为4.143(1.784~9.637),2.826(1.359~6.063),1.825(1.159~2.874),1.714(1.128~2.606)。结论HIV/AIDS患者结核分枝杆菌潜伏感染密切的相关影响因素为CD4^(+)T淋巴细胞<200 cells/μL、有结核病密切接触史、HIV感染病程≥4年、合并其他机会性感染,应关注该类人群结核病的发展趋势,及时给予预防性治疗,避免HIV病毒和结核分枝杆菌双重感染的协同恶化。

ObjectiveTo explore the status and influencing factors of mycobacterium tuberculosis latent infection in HIV/AIDS patients,and to provide basis for preventive intervention of latent infection of tuberculosis.MethodsThe patients confirmed to be HIV infected and not suffering from tuberculosis in the Fourth People′s Hospital of Nanning were selected as subjects for the IFN-γrelease test from January 2020 to March 2021,tuberculosis latent infection(LTBI)as the observation group,and HIV/AIDS patients as the control group.The epidemiological characteristics of latent infection were investigated and 12 factors,including gender,age,ethnicity,place of residence,BMI,per capita monthly income of family,underlying diseases,history of close contact with tuberculosis,history of BCG vaccination,CD4^(+)T lymphocytes,HIV infection course,and opportunistic infections,were screened by single factor atα=0.10.The results of univariate analysis were incorporated into Logistic regression analysis to explore the influencing factors of TB latent infection in HIV/AIDS patients.ResultsLTBI was found in 112 of 650 HIV/AIDS patients,with a detection rate of 17.23%.Six factors with statistical significance in univariate analysis were included in multivariate Logistic regression analysis,and the factors that were finally entered into the regression model were CD4^(+)T lymphocytes,close contact history of tuberculosis,duration of HIV infection,and combination of other opportunistic infections.The adjusted OR value and OR95%CI were respectively 4.143(1.784-9.637),2.826(1.359-6.063),1.825(1.159-2.874),1.714(1.128-2.606).ConclusionsThe closely related factors of TB latent infection were CD4^(+)T lymphocyte<200 cells/μL,close contact history of tuberculosis,HIV infection course≥4 years,and other opportunistic infections in HIV/AIDS patients.Attention should be paid to the development trend of TB in this group,and timely preventive treatment should be given,to avoid the co-aggravation of HIV and mycobacterium tuberculosis dual infection.