Factors of Adherence to Concurrent Tuberculosis Treatment and Antiretroviral Therapy among HIV-TB Co-Infected Individuals in the East Region, Cameroon in the COVID-19 Era: A Retrospective Cohort Study

Context/Objectives: Tuberculosis (TB) and HIV co-infection is a serious health problem in Cameroon. The problems associated with poor adherence to treatment are on the increase worldwide. This problem can be observed in all situations where patients are required to administer their own medication, whatever the type of illness. The general objective of this study was to assess the factors affecting adherence to treatment among HIV-TB co-infected patients in health facilities in the East Region in the COVID context. Method: A retrospective cohort study before and during COVID-19 was conducted in HIV care units in 13 health districts in the East Region of Cameroon. Data were collected using a questionnaire recorded in the Kobo Collect android application, analyzed using SPSS version 25 software and plotted using Excel. Results: The pre-COVID-19 cohort compared to the during-COVID-19 cohort had a 1.90 risk of not adhering to treatment (OR: 1.90, CI {1.90 - 3.37}) and the difference was statistically significant at the 5% level (p-value = 0.029). Frequency of adherence was 65.4% (140/214). Adherence before COVID-19 was 56.9% whereas during COVID-19, it was 74.3%. Conclusion: The implementation of targeted interventions in the COVID-19 context, using evidence-based data and integrating the individual needs of HIV-TB co-infected patients, improved adherence to concurrent anti-tuberculosis treatment and antiretroviral therapy during the COVID-19 Era.

Mathematical Modeling of the Co-Infection Dynamics of HIV and Tuberculosis Incorporating Inconsistency in HIV Treatment

A non-linear HIV-TB co-infection has been formulated and analyzed. The positivity and invariant region has been established. The disease free equilibrium and its stability has been determined. The local stability was determined and found to be stable under given conditions. The basic reproduction number was obtained and according to findings, co-infection diminishes when this number is less than unity, and persists when the number is greater than unity. The global stability of the endemic equilibrium was calculated. The impact of HIV on TB was established as well as the impact of TB on HIV. Numerical solution was also done and the findings indicate that when the rate of HIV treatment increases the latent TB increases while the co-infected population decreases. When the rate of HIV treatment decreases the latent TB population decreases and the co-infected population increases. Encouraging communities to prioritize the consistent treatment of HIV infected individuals must be emphasized in order to reduce the scourge of HIV-TB co-infection.

Factors Associated with HIV/Tuberculosis Coinfection among People Living with HIV after Initiation of Antiretroviral Treatment in Lingwala Health Zone from 2021 to 2023

Context and objective: Around 8% of incident cases of tuberculosis (TB) were reported among people living with HIV worldwide in 2022. Tuberculosis is the leading cause of death among people living with HIV. Africa accounts for the majority of co-infection episodes, with over 50% of cases in some parts of southern Africa. In the Democratic Republic of Congo (DRC), around 9% of persons living with HIV (PLHIV) develop TB and 11% of TB patients are infected with HIV. The DRC is one of the 30 countries in the world bearing the brunt of co-infection. Despite the efforts made by countries to improve access to antiretroviral traitement (ART), TB remains a major problem among people living with HIV. The Lingwala Health Zone in the provincial city of Kinshasa recorded a large number of cases of HIV/TB co-infection during the study period. The aim of this study was to determine the factors associated with HIV/TB co-infection among PLHIV on ART in the Lingwala health zone (HZ) in Kinshasa. Methods: This was a case-control study conducted in the state-run HIV care facilities in the Lingwala health district among PLHIV who had visited the health facilities during the period 2021-2023. Cases were coinfected patients and controls were PLHIV who had not developed tuberculosis during the study period. Results: A total of 281 PLHIV were enrolled in the study, with 70 cases and 211 controls. Factors associated with HIV/TB co-infection after multivariate analysis were viral load (OR = 5.34;95% CI;1.8-15.8, p = 0.005). History of tuberculosis (OR = 20.84;95% CI;8.6-50.3, p -85.0, p = 0.005) and BMI Conclusion: The results of this study indicate that the detection of these enumerated factors should prompt providers to actively search for tuberculosis with a view to organising early management.

First Nationwide Survey of the Prevalence of TB/HIV Co-Infection in Ghana

Background: To better understand the extent of the magnitude of tuberculosis (TB) and Human Immunodeficiency Virus (HIV) co-infection in Ghana, a baseline study was conducted to establish the national prevalence of the dual infection. The study aimed to determine the most prevalent HIV serotype (HIV-1 or HIV-2) in TB patients (new and old cases);genotype mycobacterial species causing TB/HIV co-infection and determine their drug susceptibility patterns. Methods: Sputum and dried blood samples were collected from 503 TB patients from 67 health facilities nationwide between December 2007 and November 2008. All samples were processed for mycobacterial and HIV testing using conventional and molecular methods. Results: A total of 517 paired sputum samples were received from 517 patients. A total 503 patients [335 (66.6%) males;168 (33.4%) females] had at least one culture positive sample. Majority (93.0%) of the patients were new cases while 7.0% were old cases. All 503 TB isolates were Mycobacterium tuberculosis complex. Of 503 blood samples, 74 were positive for HIV (14.7%), comprising 71 (14.1%) and 3 (0.6%) for HIV-1 and HIV-1 & 2 respectively;none was positive for HIV-2 alone. The seroprevalence of HIV in newly diagnosed TB patients and those already on treatment, was 69/468 (14.7%) and 5/35 (14.3%) respectively (p > 0.05). Differentiation of isolates from TB/HIV co-infected patients showed that 70/74 (94.6%) were Mycobacterium tuberculosis while 4/74 (5.4%) were Mycobacterium africanum. Monoresistance to isoniazid and rifampicin were 4/74 (5.4%) and 1/74 (1.4%) respectively;resistance to both drugs (multi-drug resistant-MDR) was not observed. Sixty nine (93.2%) isolates were susceptible to both drugs. Conclusion: The prevalence of HIV infection in TB patients was 14.7%. TB/HIV was common among the sexually active age group (25 - 34 years). Majority of the TB isolates were M. tuberculosis which were susceptible to both isoniazid and rifampicin. HIV-1 was the common serotype infecting TB patients in Ghana.

Evaluation of Tuberculosis Treatment Outcome of TB/HIV Co-Infection: A Four-Year Retrospective Cohort Study in HIV-Prevalent Setting of North Central Nigeria

Background: Despite the availability of highly effective treatment for decades, Tuberculosis (TB) remains a major health problem in Nigeria due to the increasing association between HIV and TB observed over the past three decades when HIV was discovered. However, the proportion of TB and or TB/HIV co-infected patients who have successful TB treatment outcome is not well known. This study determined the treatment outcome of TB/HIV co-infected patients with HIV negative patients in two states in Nigeria. Materials and Methods: A retrospective study of secondary data from eight Directly Observed Treatment Short (DOTS) course and Anti- Retroviral Therapy (ART) service providers in Benue and Federal Capital Territory (FCT), Nigeria, was carried out. The period under review covers January, 2010 to December, 2013. Results: Out of the total 5266 TB cases reviewed, the HIV prevalence rate was 52%. They were predominantly (53.3%) male with mean age of 34.4 years (SD = 15.1 years). More than two-third (72.5%) of HIV-negative patients had successful treatment compared to 1718 (62.7%) HIV-positive patients. Of the 2334 HIV co-infected patients, 19.5% defaulted, 11.5% had died, 5.6% were transferred out and 0.7% failed treatment compared to HIV-negative patients amongst whom 18.3% defaulted, 3.6% died, 3.9% were transferred out and 1.6% failed treatment (p Conclusion: The favourable treatment outcome of HIV-negative patients is more than that of HIV-positive patients and the most probable predictable factor responsible is the CD4 count of patient;indicating that TB/HIV co-infection has remained a major public health problem in Benue state and FCT. Hence there is the need for sustained strengthening and expansion of the national TB/HIV programmes.

Using Statistical Learning to Treat Missing Data: A Case of HIV/TB Co-Infection in Kenya

In this study, we investigate the effects of missing data when estimating HIV/TB co-infection. We revisit the concept of missing data and examine three available approaches for dealing with missingness. The main objective is to identify the best method for correcting missing data in TB/HIV Co-infection setting. We employ both empirical data analysis and extensive simulation study to examine the effects of missing data, the accuracy, sensitivity, specificity and train and test error for different approaches. The novelty of this work hinges on the use of modern statistical learning algorithm when treating missingness. In the empirical analysis, both HIV data and TB-HIV co-infection data imputations were performed, and the missing values were imputed using different approaches. In the simulation study, sets of 0% (Complete case), 10%, 30%, 50% and 80% of the data were drawn randomly and replaced with missing values. Results show complete cases only had a co-infection rate (95% Confidence Interval band) of 29% (25%, 33%), weighted method 27% (23%, 31%), likelihood-based approach 26% (24%, 28%) and multiple imputation approach 21% (20%, 22%). In conclusion, MI remains the best approach for dealing with missing data and failure to apply it, results to overestimation of HIV/TB co-infection rate by 8%.

Characterization of TB/HIV Co-Infected Patients Receiving TB Treatment at a DOTS Clinic, in a Tertiary Hospital in South-Eastern Nigeria

Background: Tuberculosis (TB) is a specific infectious disease caused by mycobacterium tuberculosis while acquired immune deficiency syndrome (AIDS) is a fatal illness caused by human immunodeficiency virus (HIV). Both of them constitute the main burden of infectious public health disease in many parts of the world, particularly in resource limited countries like Nigeria. This study sets out to describe TB/HIV co-infected patients accessing care at the DOTS clinic in a tertiary hospital in South-Eastern Nigeria. Methods: This study was conducted retrospectively at the DOTS clinic of NAUTH Nnewi. A structured proforma was used to extract specific characteristics of TB/HIV co-infected patients who received TB treatment for the period of 1st January 2013 to 31st December 2013. The collected data were analyzed with SPSS version 20. Results: Ninety eight patients (40.6%) were TB/HIV co-infected, out of the two hundred and forty one patients treated for tuberculosis in the DOTS clinic during the period under review. These were the findings among the TB/HIV co-infected patients: there were more females (51%) than males (49%);the commonest age group affected was the group 30 - 39 years (34.7%);majority of the patients (91.8%) had pulmonary TB as against extrapulmonary TB (8.2%) and most of the patients had negative sputum AFB result (43.9%) as against those with positive result (36.7%). Conclusion: This study demonstrated some important characteristics of TB/HIV co-infected patients. Such knowledge if taken into consideration in both the tuberculosis control and HIV control programs will improve the outcomes of the programs.

Model of the Effects of Improving TB Diagnosis on Infection Dynamics in Differing Demographic and HIV-Prevalence Scenarios

This paper seeks to examine the sensitivity of tuberculosis transmission (TB) dynamics to the rate at which infectious individuals with active TB begin a TB treatment course, and therefore cease to be infectious to others. We model this by varying both the rate at which individuals are diagnosed and begin treatment, and the demographic conditions in which the epidemic occurs. An agestructured deterministic ordinary differential equation model is used to study the sensitivity of TB transmission dynamics to the implementation of a more effective diagnostic such as Xpert MTB/ RIF in a high HIV prevalence setting. Sensitivity analysis of the effectiveness of the diagnostic (λ) shows the interim disease dynamics in three demographic scenarios defined by differences in HIV prevalence and age structure at a constant transmission rate. In the near future, we expect the diagnostic to have the most effect in areas of high HIV prevalence. In the long term, we expect the diagnostic to have the most significant impact at high transmission rates regardless of HIV prevalence and age structure.

HIV Infection among Newly Diagnosed TB Patients in Southwestern Nigeria: A Multi-DOTS Center Study

Backgroud: The burden of TB and HIV infection is estimated to be about 512/100,000 and 3,000,000 people respectively. However, accurate data on TB/HIV co-morbidity in different parts of Nigeria were not available due to limited access to HIV Counseling and Testing (HCT) by individuals with TB infection. This study was designed to determine the true rate of HIV infection among newly diagnosed TB patients by providing comprehensive HCT services in 43 DOTS centers in Oyo State, Southwestern Nigeria. Methods: All patients meeting the case definition for TB suspects who presented at each of the 43 DOTS Centres were counselled and those who consented tested for presence of HIV antibodies using HIV 1/2 Determine, Unigold and Stat-Pak rapid test kits in a serial algorithm. Results: A total of 13,109 TB positive patients were enrolled for the study, out of which 1605 (12.3%) tested positive for HIV antibodies. HIV infection was higher among female (15.5%) than male (9.5%) TB patients (p 0.05). The rates also varied among the age groups, ranging from 4.3% in the 10 - 19 years to 18.0% in the 40 - 49 years age group. A relatively high rate (10.5%) of HIV infection was found among children less than ten years of age. Conclusion: The results of this work show the true burden of TB/HIV in any region in Nigeria for the first time. Higher rate of TB/HIV co-infection among female patients and children are significant and important factors that should be considered in the planning of intervention measures in Nigeria and other TB and HIV endemic countries in Africa.

TB/HIV双重感染防治工作机制研究

[目的]探索TB/HIV双重感染防治工作机制。[方法]在四川省选择结核病和艾滋病疫情均较重的两个县开展为期6个月的试点研究。[结果]通过研究,探索出了"4个一"工作协调机制和"一初筛、二转诊、三检查、四诊断、五鉴别"的工作模式,以及并由结防人员采血、告知阴性结果,由艾防人员检测、告知阳性结果的HIV抗体检测和咨询程序。结核病人中HIV检出率为2.40%,HIV/AIDS中结核病的检出率为5.06%。[结论]在结防机构和艾防机构间建立一套有机的协作机制是做好TB/HIV双重感染防治工作的基础。

HIV/AIDS与TB双重感染及其影响因素的流行病学研究

目的调查广西HIV/AIDS患者中结核病检出率,结核病患者中HIV感染检出率;了解广西HIV/AIDS患者发生结核病及结核病患者感染HIV的影响因素。方法利用艾滋病专科门诊对321例HIV/AIDS患者、结核病专科医院对580例结核病患者进行双重感染的检测,并对其影响因素进行流行病学调查。结果HIV/AIDS患者中结核病检出率为30.5%(肺结核为25.2%,肺外结核为5.3%),结核病患者中HIV感染检出率为2.8%;影响HIV/AIDS患者发生结核病的主要影响因素为CD4淋巴细胞计数水平、性别和月均收入,影响结核病患者感染HIV的主要影响因素为共用针具静脉吸毒和商业性行为。结论HIV/AIDS患者发生结核病的机率高,CD4淋巴细胞计数水平低、男性、月均收入低者易发生结核病;结核病患者中HIV感染检出率高于一般人群,共用针具静脉吸毒和商业性行为是结核病患者感染HIV的主要途径。

TB/HIV双重感染诊断治疗专家组合作机制现状与影响因素分析

目的定性调查基层结核杆菌/艾滋病病毒(TB/HIV)双重感染诊断治疗专家组合作机制及其影响因素,为制定国家TB/HIV双重感染合作机制提供科学依据。方法选择已经开展TB/HIV双重感染的3县(区),使用观察法和关键知情人深入访谈的方法,了解TB/HIV双重感染防治合作现状和影响因素。结果成立TB/HIV双重感染诊断治疗专家组是十分必要的,且需要建立由结核病专家和艾滋病专家组成的诊断治疗专家组;三县为开展TB/HIV双重感染工作,初步建立了疾病预防控制机构或传染病专科医院为中心的会诊模式;会诊中以HIV/AIDS中结核病的诊断和治疗方案为主。但是领导重视程度和协调机制、专家诊断治疗水平、医疗机构参与、医生态度和投入的时间等因素仍然是导致诊疗延误的重要因素。结论建立结核病/艾滋病双重感染诊断治疗专家组,是结核病/艾滋病防治合作机制的重要内容。通过加强领导重视和制度建设;加强疾病预防控制机构和医疗机构间的协调力度;医患双方的宣传教育健全合作机制,避免和减少延迟诊治。

结核病与艾滋病防治机构合作防治TB/HIV双重感染研究

目的探索TB/HIV双重感染防治机构间一种科学的、可行的合作模式。方法省、市、县三级分别成立由结核病和艾滋病防治机构专业人员组成的项目小组,负责本级项目实施和管理工作。结核病和艾滋病专业人员联合进行培训、定期召开协调会议、共同督导访视。合作对确诊的结核病人进行咨询及HIV抗体检测。合作对确诊的HIV/AIDS进行结核病筛查。结果省、市、县三级疾病预防控制中心内部结核病与艾滋病防治机构建立了防治TB/HIV双重感染合作模式,并运行良好。399例HIV/AIDS病例中确诊结核病人6例,TB/HIV双重感染率为1.5%。结论疾病预防控制中心内部结核病与艾滋病机构间的合作开展TB/HIV双重感染防治是有效和可行的。

桂西地区艾滋病病毒与结核菌双重感(HIV/TB)患者心理健康及社会支持情况研究结果分析

目的:了解HIV/TB患者心理健康状况与其应对方式及社会支持度的现状并分析它们之间的关系,为今后对这类特残人群的干预措施调提供科学依据。方法运用心理卫生评定量表手册中的SCL-90、SCSQ和SSRS三个量对桂西地区(百色市)103对HIV/TB患者和健康对照者进行问卷调查,比较其异同并进行相关分析。结果:SCL-90调查结果。病患组的总均分和各因子得分除"偏执"和"其他"两项外均显著高于对照组;HIV/TB双重感染患者积极应对显著少于对照组,反之消极应对也显著多于对照,病患者组的社会支持力度上无论是主观支持还是客观支持都显著小于对照组;经过回归分析发现HIV/TB双重感染患者心理健康严重程度与社会支持总得分、主观支持、客观支持三个因素有显著负相关,与积极应对有显著正相关。结论:HIV/TB双重感染患者由于疾病特殊,加上社会支持的不足,其心理健康出现了诸多问题,要做好此类病患者的防治工作,需要在心理方面对患者进行疏导,多开展疾病的知识宣教等,同时动员全社会的力量,共同关怀、共同努力、消除歧视,营造一个利于患者的环境,才能工作做好。

HIV/TB并发感染患者外周血T淋巴细胞表达及与HIV RNA载量的相关性研究

目的探讨人类免疫缺陷病毒/结核病(human immunideficiency virus/tuberculosis,HIV/TB)并发感染患者的外周血T淋巴细胞亚群的表达及其与HIV RNA载量的相关性。方法选取2018年6月~2020年6月在南京市公共卫生医疗中心就诊的HIV/TB并发感染患者38例作为HIV/TB组,另选取单纯人类免疫缺陷病毒/获得性免疫缺陷综合征(human immunodeficiency virus/acquired immune deficiency syndrome,HIV/AIDS)39例作为HIV组,单纯TB患者35例作为TB组,体检健康者35例作为健康对照组。流式细胞术检测各组CD3^(+),CD4^(+),CD8^(+)T细胞计数和CD4^(+)/CD8^(+)比值;荧光定量PCR检测HIV RNA载量。采用SPSS17.0统计学软件进行统计分析,并进行Spearman相关系数分析。结果CD3^(+),CD4^(+)和CD8^(+)T细胞数,CD4^(+)/CD8^(+)比值在各组中的差异均具有统计学意义(H=40.758,104.279,9.637和101.770,均P<0.05),组间两两比较结果表明,与健康对照组相比,TB组CD3^(+)和CD8^(+)T细胞数明显降低,差异均有统计学意义(Z=-2.520,-2.972,P=0.012,0.003);HIV组和HIV/TB组CD3^(+),CD4^(+)T细胞数以及CD4^(+)/CD8^(+)比值均明显降低(Z=-7.391~-4.325,均P=0.000)。与TB组相比,HIV组CD3^(+),CD4^(+)T细胞数和CD4^(+)/CD8^(+)比值均明显降低,差异均有统计学意义(Z=-2.138,-7.032和-7.380,P=0.032,0000和0.003),但CD8^(+)T细胞数明显升高(Z=-2.463,P=0.014);而HIV/TB组CD3^(+)和CD4^(+)T细胞数以及CD4^(+)/CD8^(+)比值均明显降低,差异均有统计学意义(Z=-3.865,-6.907和-6.759,均P=0.000)。与HIV组相比,HIV/TB组的各项流式指标及HIV RNA载量差异均无统计学意义(均P>0.05)。HIV RNA载量与CD3^(+),CD4^(+),CD8^(+)T细胞数以及CD4^(+)/CD8^(+)比值均呈显著负相关(r分别为-0.327,-0.370,-0.296和-0.327,均P<0.05)。结论HIV/TB并发感染患者外周血CD3^(+),CD4^(+)T细胞数和CD4^(+)/CD8^(+)比值均明显降低。无论有无并发TB感染,HIV感染者的细胞免疫功能均随着病毒载量的升高而显著降低。

健康教育路径在TB/HIV双重感染患者治疗督导中的应用

目的探讨健康教育路径在结核/人类免疫缺陷病毒(TB/HIV)双重感染患者治疗督导中的应用效果。方法将100例TB/HIV双重感染患者分为对照组和实验组,每组各50例,对照组实施常规健康教育,实验组按制订的健康教育路径实施健康教育。结果经过系统性健康教育及全程督导,实验组疾病知识掌握率、服药依从性明显提高(P<0.01)。结论实施健康教育路径能有效提高TB/HIV双重感染患者对专科疾病知识的掌握率和服药依从性,减少药物副反应及耐药性的发生。

2010—2021年广西TB/HIV双重感染监测及结核检测情况分析

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。

Unfavourable TB Outcomes in PLHIV with Delayed TB Treatment Initiation—A Retrospective Analysis

Background & Objectives: Timely initiation of anti-tubercular treatment (ATT) is key to obtain favourable outcomes among people living with HIV (PLHIV) co-infected with tuberculosis (TB). There is little evidence to predict treatment outcome and the delay in initiation of ATT among co-infected. The analysis explores the relationship between different ATT initiation delay times and TB outcomes. Methods: Retrospective analysis of secondary data of HIV-TB co-infected patients attending two antiretroviral therapy (ART) clinics in Pune district of Maharashtra, India. Logistic regression models were used to calculate risk. Results: Of the total 457 co-infected PLHIV initiated on ATT from December 2016 to June 2018, there were 298 who had completed TB treatment. Outcomes of ATT were available for 243 patients. Of the 243 patient’s records analysed, 61% were males and ≤11% were less than 18 years. 20% were previously treated. The risk of unfavourable outcomes increased monotonically from OR = 1.1, to OR = 1.73 for >2 days to >7 days delay in ATT initiation respectively. Males (OR = 2.11), newly initiated patients (OR = 1.54) are exposed to higher risk of unfavourable TB outcomes when ATT initiation is delayed beyond seven days. Conclusion: Risk of unfavourable outcomes increase in delay time for ATT initiation. Patient characters should be considered for prioritised referral and availability of test results on the same day of diagnosis to foster same day ATT initiation. More analysis on larger data sets with richer clinical information will generate confirmatory evidence.

江苏省未接受治疗的HIV感染者和患者免疫功能状况研究

目的:了解江苏省HIV感染者T淋巴细胞的变化及合并结核杆菌感染的情况,为抗病毒治疗提供参考依据。方法:应用流式细胞仪、X线拍片机及痰检的方法分析140例正常人、116例HIV感染者的T淋巴细胞亚群及其合并结核的情况。结果:HIV感染者CD4+细胞数低于正常人群(P<0.001),CD4+/CD8+的比值明显降低(P<0.001);CD4+细胞<200个/μl者占37.07%,>200个/μl者占62.93%,两组人群的CD8+T淋巴细胞、Th/Ts有显著性差异;其中77.59%无临床症状,有临床相关症状的占22.41%,两组人群的CD4+细胞数及Th/Ts有显著性差异;共11例合并结核感染。结论:HIV感染机体后,CD4+、CD8+细胞水平的变化与病情发展关系密切,联合检测的判断能力优于单项检测。

PKCδ与MALT1对HIV-TB共感患者细胞免疫应答的作用

目的分析艾滋病与结核病双重感染(HIV-TB)患者外周血单个核细胞中PKCδ与MALT1对Th17细胞水平、炎症因子水平及mRNA表达水平的影响。方法收集2021年6月-2022年8月喀什地区第一人民医院收治的HIV-TB共感患者4例,分离外周血单个核细胞(PBMC)培养后分为空白对照组和B106组[PKCδ抑制剂(B106)处理细胞]、MI-2组[MALT1抑制剂(MI-2)处理细胞]、B106+MI-2组[PKCδ抑制剂(B106)与MALT1抑制剂(MI-2)共同处理细胞]3个试验组。应用流式细胞术检测Th17细胞水平;采用ELISA法检测IL-6、IL-17、IL-23、IFN-γ、TNF-α、IL-10以及IL-22的水平及运用qPCR检测MALT1、Iκbα、P65以及IL-17、IL-23的mRNA表达水平,探讨PKCδ与MALT1对HIV-TB共感患者中细胞免疫应答的影响,并初步分析其作用机制。结果3个试验组中Th17细胞的数量均高于对照组,差异有统计学意义(P<0.05);3个试验组中IL-6、IL-17、IL-23、IFN-γ、TNF-α、IL-10以及IL-22的浓度均低于对照组,差异有统计学意义(P<0.05),但3个试验组之间比较,差异无统计学意义(P>0.05);3个试验组中IL-17、IL-23的mRNA表达水平均低于对照组,差异有统计学意义(P<0.05);B106组MALT1、P65表达低于对照组,Iκbα表达高于对照组,差异有统计学意义(P<0.05),MI-2组Iκbα表达高于对照组,P65表达低于对照组,差异有统计学意义(P<0.05);B106+MI-2组与其他2个试验组比较,差异无统计学意义(P>0.05)。结论抑制PKCδ或MALT1可拮抗HIV-TB共感患者的Th17细胞数量下降,抑制HIV-TB的炎症反应,抑制SYK/PKCδ/CARMA1-Bcl10-MALT1(CBM)复合物通路,可通过抑制NF-κB炎症通路拮抗HIV-TB的炎症反应。