2010—2021年广西TB/HIV双重感染监测及结核检测情况分析

Analysis of surveillance data of TB/HIV co-infection and tuberculosis detection in Guangxi from 2010 to 2021

目的掌握广西TB/HIV(结核菌/艾滋病病毒)双重感染疫情变化趋势,了解双向转介筛查、病原学监测和综合治疗情况,为进一步完善双重感染诊疗及防控工作的策略提供参考依据。方法收集、整理和分析2010—2021年广西各地结核病防治机构及艾滋病防治机构共同上报的双重感染防治年度报表和病原学监测结果;使用四种方法分别对HIV感染者进行结核检测,比对分析检测方法的检测效率。结果2010—2021年广西HIV/AIDS患者的TB症状平均筛查率为89.43%,平均TB检出率为2.01%;年度TB症状筛查率呈升高趋势(趋势χ^(2)=23159.66,P<0.001);年度TB检出率呈下降趋势(趋势χ^(2)=327.25,P<0.001)。TB患者平均接受HIV抗体检测率为78.78%,平均HIV阳性率为0.94%,年度接受HIV检测率呈升高趋势(趋势χ^(2)=57001.46,P<0.001),年度HIV阳性率呈下降趋势(趋势χ^(2)=181.78,P<0.001)。平均综合治疗率为53.89%,年度综合治疗率呈上升趋势(趋势χ^(2)=674.48,P<0.001)。平均抗结核治疗成功治疗率为79.83%,平均双重感染患者结核病死率为0.67%。年度成功治疗率呈上升趋势(趋势χ^(2)=106.97,P<0.001),年度结核病死率呈下降趋势(趋势χ^(2)=23.66,P<0.001)。综合治疗率在HIV低流行地区高于HIV高流行地区(χ^(2)=982.38,P<0.001);艾滋病防治机构与结核病防治机构登记治疗双重感染患者数逐年趋于一致(χ^(2)=247.26,P<0.001)。病原学专项监测数据显示,结核病分枝杆菌(MTB)潜伏感染率为25.76%;培养阳性检出率为2.31%;对HIV感染患者进行结核分枝杆菌潜伏感染检测,T细胞干扰素释放试验免疫斑点法(T-SPOT)阳性率低于全血干扰素释放试验酶联免疫法(QFT)(P=0.022);病原学检测阳性率液体培养法高于固体培养法(P=0.001)。结论广西的TB/HIV双重感染监测和防治工作取得一定成效,但部分地区诊疗覆盖面仍较低,需完善综合诊疗管理机制,加大资源投入,实现减低TB/HIV双重感染疫情的目标。

Objective To master the trend of TB/HIV(tuberculosis/HIV)co-infection in Guangxi,understand the situation of two-way referral screening,etiological monitoring and comprehensive treatment,and provide reference for further improving the strategy of co-infection diagnosis and control and prevention.Methods Annual reports of co-infection prevention and control and etiological surveillance results jointly reported by tuberculosis and AIDS prevention and control institutions in Guangxi from 2010 to 2021were collected,sorted and analyzed.Four methods were used to detect tuberculosis in HIV infected patients,and the detection efficiency of these methods was compared and analyzed.Results From 2010 to 2021,the average TB symptom screening rate among HIV/AIDS patients in Guangxi was 89.43%,and the average TB detection rate was 2.01%.The annual TB symptom screening rate was increased(χ^(2)trend=23159.66,P<0.001),and the annual TB detection rate was decreased(χ^(2)trend=327.25,P<0.001).The average HIV antibody detection rate among TB patients was 78.78%,and the average HIV positive rate was 0.94%.The annual HIV detection rate was increasing(χ^(2)trend=57001.46,P<0.001),and the annual HIV positive rate was decreasing(χ^(2)trend=181.78,P<0.001).The average rate of comprehensive treatment was 53.89%,and the annual rate of comprehensive treatment was increasing(χ^(2)trend=674.48,P<0.001).The average successful rate of anti-tuberculosis treatment was 79.83%,and the average tuberculosis mortality rate in patients with co-infection was 0.67%.The annual successful treatment rate showed an upward trend(χ^(2)trend=106.97,P<0.001),and the annual mortality rate showed a downward trend(χ^(2)trend=23.66,P<0.001).The rate of comprehensive therapy in low HIV prevalence area was higher than that in high HIV prevalence area(χ^(2)=982.38,P<0.001).The number of co-infection patients registered and treated in AIDS prevention and control institutions and tuberculosis prevention and treatment institutions tended to be consistent year by year(χ^(2)=247.26,P<0.001).The special surveillance data of etiology showed that the latent infection rate of Mycobacterium tuberculosis(MTB)was 25.76%.The positive detection rate of culture was 2.31%.HIV-infected patients were detected for latent infection of Mycobacterium tuberculosis,and the positive rate of T-cell interferon release test immunospot assay(T-SPOT)was lower than that of whole blood interferon release test-Quati FERON-TB Gold(QFT)(P=0.022).The positive rate of pathogenic detection was higher in liquid culture than solid culture(P=0.001).Conclusion The monitoring and prevention of TB/HIV co-infection in Guangxi has achieved some effects,but the coverage of diagnosis and treatment in some areas is still low.It is necessary to improve the comprehensive diagnosis and treatment management mechanism,increase the investment of resources,and achieve the goal of reducing the epidemic of TB/HIV co-infection.