TB/HIV Coinfection and Other Medical Co-Morbidity in Older Adults (50 - 64 Years) in Botswana: Evidence from 2013 Botswana AIDS Impact Survey (BAIS IV)

Background: Many older adults (50 - 64 years) in Botswana with HIV do not know they are infected with TB. Some with TB disease are unaware of their HIV status, yet HIV/TB coinfection is high. The study aims to determine the prevalence of TB among older adults with HIV, their HIV/AIDS knowledge and vulnerability to hypertension, diabetes and asthma using the 2013 BAIS IV data. Material and Methods: The BAIS IV study, from which the data for this article is derived, used a stratified two-stage probability sampling design. The first stage was the selection of 297 Enumeration Areas (EAs) as Primary Sampling Units and second stage was selection of households (5,415) in the EAs. The study targeted all usual members of the selected households aged 6 weeks and above for the Biomarker or testing for HIV and those aged 10 - 64 years old for the behavioral questionnaire. Results: The study shows that the older adults (50 - 64 years) with TB have a low level of education and HIV prevalence is very high (44% for age 50 - 54, 40.6% for age 55 - 59 and 68.4% for age 60 - 64 years). The rate of HIV/TB coinfection, 21.9%, is high and prevalence of TB among the older adults is 8.6% (13%, males and 5.3%, females) while only 0.8% are currently on treatment. Only 67.2% know that if a pregnant mother is infected with HIV, there is a way of preventing transmission of the virus to the child. Age, level of education, marital status and employment status significantly (p Conclusion: The study concludes that lower education seems to be an obstacle to accessing TB treatment. Therefore, older adults’ awareness and knowledge of the symptoms of both diseases (TB and HIV), mode of infection and treatment need to adequately improve through increased education to overcome health challenges when infected with asthma, diabetes and high blood pressure/hypertension.

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.

Treatment of chronic hepatitis C in patients with HIV/HCV coinfection

Hepatitis C virus(HCV) infection is one of the mostfrequent causes of comorbidity and mortality in the human immunodeficiency virus(HIV) population, and liver-related mortality is now the second highest cause of death in HIV-positive patients, so HCV infection should be countered with adequate antiviral therapy. In 2011 began the era of directly acting antivirals(DAAs) and the HCV NS3/4A protease inhibitors telaprevir and boceprevir were approved to treat HCV-genotype-1 infection, each one in combination with pegylated interferon alfa(Peg-IFN) + ribavirin(RBV). The addition of the first generation DAAs, strongly improved the efficacy of antiviral therapy in patients with HCVgenotype 1, both for the HCV-monoinfected and HIV/HCV coinfected, and the poor response to Peg-IFN + RBV in HCV/HIV coinfection was enhanced. These treatments showed higher rates of sustained virological response than Peg-IFN + RBV but reduced tolerability and adherence due to the high pill burden and the several pharmacokinetic interactions between HCV NS3/4A protease inhibitors and antiretroviral drugs. Then in 2013 a new wave of DAAs arrived, characterized by high efficacy, good tolerability, a low pill burden and shortened treatment duration. The second and third generation DAAs also comprised IFN-free regimens, which in small recent trials on HIV-positive patients have shown comforting preliminary results in terms of efficacy, tolerability and adherence.

2016—2023年内蒙古自治区TB/HIV双重感染流行特征及治疗情况分析

目的:通过对内蒙古自治区2016—2023年TB/HIV双重感染流行特点进行数据分析,为全区TB/HIV防控提供科学依据。方法:采用描述流行病学方法,运用“登记率”、“检查率”和“治疗成功率”等指标分析内蒙古自治区TB/HIV双重感染患者的流行病学特点;运用趋势卡方检验及Fisher确切概率法分析内蒙古TB/HIV双重感染患者在2016-2023年间的三间分布、治疗情况。结果:2016—2023年全区登记HIV/AIDS患者43703例,接受胸片或痰涂片检查41049例,检出结核病患者158例,检查率为93.93%,检查率呈逐年上升态势(χ^(2)_(趋势)=272.970,P<0.001),结核病检出率为0.36%,检出率总体呈下降趋势(χ^(2)_(趋势)=21.623,P<0.001);2016—2023年新检出7595例HIV/AIDS患者,6866例进行了胸片或痰检,检查率为90.40%,检出结核病患者93例,检出率为1.35%;既往HIV/AIDS患者进行胸片或痰检累计34183例次,检出结核病患者65例,2016—2023年既往HIV/AIDS患者结核病检出率均低于新检出HIV/AIDS患者结核病检出率;2016-2023年全区结核病患者HIV抗体阳性筛查比例为23.69%,呈明显升高态势(χ^(2)_(趋势)=5764.882,P<0.001);内蒙古TB/HIV双重感染患者的登记率2016-2018年逐年上升(χ^(2)_(趋势)=4.685,P=0.03),2019-2023年基本不变(χ^(2)_(趋势)=1.084,P趋势=0.179);不同盟(市)双感患者平均登记率存在差异(χ^(2)=41.565,P<0.001);25~44岁年龄组累计TB/HIV双重感染者最多(57.40%);2016—2023年发现的169例双重感染患者在结核病专报系统的登记率为85.21%。接受抗结核治疗的为133例,治疗成功率71.43%。结论:内蒙古2016-2023年TB/HIV双筛率逐年提高。每年的TB/HIV双重感染病例约为20例,登记率水平有所波动。今后要继续做好对重点地区、重点人群的监测管理工作,及时登记并提供优质的治疗管理服务。

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.

Buruli Ulcer and HIV Coinfection: Cases in Togo

Background: In Togo, as in all sub-Saharan countries, the burden of HIV infection remains high. The registration of new cases of Buruli ulcer every year also remains a major public health problem. Buruli ulcer (BU) is a disabling disease and the presentation of lesions is frequently severe. A feature of BU and HIV coinfection is the rarity of cases, which makes its study difficult, but, nevertheless, important to study its seroprevalence, biological data, risk factors and genetic diversity. The purpose of this study is to explore the comorbidity of Buruli ulcer and HIV by evaluating HIV seroprevalence in BU patients, assessing demographic data, reviewing biological data including CD4+ T cell count, hemoglobin levels, and viral loads, and evaluating clinical and therapeutic data. Methods: This is a cross-sectional study including only BU patients confirmed by Ziehl Neelsen staining and IS 2404 PCR. The patients were hospitalized in the National Reference Center for Tsevie. They were recovered patients and patients undergoing outpatient treatment in the Gati and Tchekpo Deve treatment centers, respectively, within the Sanitary Districts of Zio and Yoto of the Maritime Region during the period from August 2015 to March 2017. Results: The number of HIV-positive BU patients is 4 out of a total of 83 BU patients. All patients are HIV-1 positive. HIV prevalence among BU patients is 4.8% compared to 2.5% nationally and 3% at regional level. Three BU patients are seropositive out of a total of 46 female patients while one patient under 15 years is seropositive out of a total of 37 male BU patients. There are a greater proportion of female patients with BU/HIV coinfections. Half of the BU/HIV positive patients (BU/HIV+) have a CD4+ TL of fewer than 500 cells/μl and the difference is significant between those of the BU HIV- and those of the BU/HIV+ patients. Two patients have undetectable viral loads while the other two have more than 1000 copies/ml (33,000 and 1,100,000 copies/ml). Anemia is significantly present in BU/HIV+ patients with a p-value = 0.003. Half of BU patients have primary education, while three-quarters of BU/HIV+ patients have no education. All patients are either in stage I or stage II of the AIDS WHO classification. All patients are on first line ARV therapy and only ARV nucleoside reverse transcriptase inhibitors (NRTIs) are used. Conclusion: In Togo, the prevalence of HIV in BU patients, although higher, is not significantly different from that of national and regional. The relatively high CD4+ LT levels of relatively high BU HIV + patients, undetectable viral loads, and AIDS WHO stages I and II indicate good quality management. Author Summary: Buruli ulcer disease (BUD) is a mycobacterial skin disease that leads to extensive ulcerations and causes disabilities in approximately 25% of the patients. Co-infection with HIV is described by the authors through the prism of risk factors and the severity of ulcerations. Healing time is described as longer than in BU/HIV- patients. The scarcity of cases seems to be an obstacle for further study. Noteworthy are the study of cases in Benin and the study of cohort cases in Cameroon. However, no study appears to be based on the seroprevalence of this morbid association, the biological data and the antiretroviral regimens. These regimens, if poorly instituted, conflict with antimycobacterial drugs against Buruli ulcer. This study, although confronted with the particular configuration of Togo, a country with a low HIV prevalence of 2.8% national prevalence and an average of 55 cases of Buruli ulcer per year, is studying the biological aspects of co-infection HIV/BU, including seroprevalence of HIV, CD4+ LT levels, patient viral load and hemoglobin levels and ARV regimens. This study shows the need for future studies, including the study of the genetic diversity of circulating Mycobacterium ulcerans strains in Togo and the study of Buruli ulcer co-infection/HIV and tuberculosis.

Prevalence of Coinfection with Malaria and HIV among Children in Yaoundé, Cameroon: A Cross-Sectional Survey Performed in Three Communities in Yaoundé

Background: Malaria and HIV are endemic in Cameroon. But data on the prevalence of coinfection with malaria and HIV in Cameroonian children are essentially absent. This study was aimed at determining the prevalence of coinfection with malaria and HIV among children in Yaoundé, so as to advice control policies. Methods: In a cross-sectional survey, children (≤15 years) were recruited from 3 communities in Yaoundé namely: Efoulan, Biyem-assi and Cité-verte. A semi-structured questionnaire was used to collect demographic data. Participants were screened for malaria parasites by the examination of Giemsa-stained blood films meanwhile participants were screened for HIV following Cameroon’s national algorithm. The Pearson’s chi-square test was performed as part of the statistical analyses. Statistical significance was set at p Result: Three hundred and ten (310) children took part in the study. The mean age (±SD) of the participants was 75.64 (±63.23) months and a majority of them were males (56.1%). The prevalence was 19.7%, 4.8% and 1.2% for malaria, HIV, and coinfection with malaria and HIV respectively. The prevalence of malaria was associated with age (p = 0.009) meanwhile the prevalence of HIV was associated with study site (p = 0.024). Plasmodium falciparum was the only species identified as causing malaria in the target population. Conclusion: A substantial prevalence of malaria, HIV and coinfection with malaria and HIV was observed in this study. Efforts should be strengthened to control and eventually eliminate these diseases in the target population.

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。

云南省3县TB/HIV患者结核病知识知晓率及影响因素分析

目的分析云南省TB/HIV患者的流行特征和结核病知识知晓率及其影响因素,为进一步加强云南省结核病健康促进和健康教育工作提供理论依据。方法对2010年1月—2012年6月期间218名TB/HIV患者进行结核病知识知晓率的问卷调查。统计分析采用单因素分析和Logistic回归分析。结果调查对象结核病知识综合得分为(8.23±2.01)分。职业(χ2=22.515)、婚姻状况(χ2=50.110)、患者来源(χ2=6.378)、住院治疗(χ2=3.915)、管理方式(χ2=4.579)及抗病毒治疗(χ2=11.342)各组间差异均有统计学意义(P均<0.05)。Logistic回归分析显示,影响结核病知识综合得分的因素有患者来源(Waldχ2=6.277,P=0.02)和抗病毒治疗(Waldχ2=10.678,P<0.001)。结论云南省TB/HIV患者结核病核心信息总知晓率为82.29%,高于全国结核病防治知识80%的目标。应根据不同地区、不同人群的特点,针对性的制作各种不同的宣传材料,积极宣传结核病的防治知识。

云南省7县TB/HIV双重感染患者社会支持状况分析

目的以SSRS社会支持评定量表作为该类患者社会支持程度的测量工具,初步了解云南省7个县TB/HIV双感患者的社会支持状况,探讨其影响因素。方法利用公认的SSRS量表回顾性调查这些TB/HIV双感患者的社会支持状况。采用到的统计学方法有统计描述、t检验、方差分析、多重线性回归分析。结果共调查215例TB/HIV双感患者,他们的社会支持平均分为(30.78±7.28)分,影响社会支持状况的因素有性别(t=-2.035,P=0.043)、户籍(t=-38.565,P=0.001)、结核病治疗分类(t=2.625,P=0.009)和抗艾滋病病毒治疗(t=0.179,P=0.004)。结论云南省双感患者的社会支持状况不理想,需要在药物治疗的同时,应主动了解他们的心理状况,主动给予他们关心和帮助,改善其心理状况。

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。

具有线性免疫响应的HIV-TB共感染模型

研究HIV与TB发生共感染时的免疫系统 抗原模型。确定了各类平衡点存在的条件以及它们的稳定性,证明了局部稳定性蕴涵全局稳定性。

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。

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。

3种用药方案治疗HIV/TB患者抗结核药物性肝损伤成本-效果分析

目的探讨3种不同治疗方案用于治疗HIV/TB患者抗结核药物性肝损的经济效果。方法将168例患者随机分成3组,A组还原型谷胱甘肽序贯、B组复方甘草酸苷序贯,C组还原型谷胱甘肽静滴序贯复方甘草酸苷口服,观察疗效和不良反应。结果 3种药物治疗方案成本分别为1221元、1076.5元、960.7元;发生不良反应率分别为50%、41.1%、44.6%(P>0.05);成本-效果比分别为12.91、12.83、10.55;有效率分别为94.6%、83.8%、91.1%(P<0.05);三种方案治疗HIV/TB患者抗结核药物性肝损在有效率上无显著差异,在A、B两组肝功能上(总胆红素)有显著差异。结论还原型谷胱甘肽静滴序贯复方甘草酸苷口服方案为较佳方案。

3种用药方案治疗HIV/TB患者抗结核药物性肝损伤126例临床疗效分析

目的探讨3种不同治疗方案用于治疗HIV/TB患者抗结核药物性肝损伤的有效性及安全性。方法将126例患者随机分成3组,A组(还原型谷胱甘肽口服)、B组(复方甘草酸苷口服),C组(还原型谷胱甘肽+复方甘草酸苷静滴),观察比较疗效。结果 3种药物治疗方案有效率分别为92.9%、90.5%、97.6%(P>0.05),治愈率分别为52.4%、45.2%、71.4%(P<0.05),发生不良反应率分别为31%23.8%47.7%(P>0.05);三种方案治疗HIV/TB患者抗结核药物性肝损伤在有效率和不良反应发生率方面无显著差异,但在治愈率上三组有显著差异。结论 C组临床疗效最好。

液体培养分枝杆菌及药敏实验诊断HIV/TB双重感染患者临床价值的研究

目的分析江西省南昌市HIV/TB双重感染患者分枝杆菌特征、菌株特性及耐药情况,为流行病学分析、临床确诊及治疗预后提供依据。方法收取HIV/AIDS疑似感染分枝杆菌患者标本139例(痰标本130例,局部组织等9例,去除重复),采取抗酸染色和菌株分离。将分离出的抗酸菌株传代培养,行菌种鉴定同时做一线药敏试验分析。结果 139份标本分枝杆菌抗酸染色的阳性率为6.5%(9/139)。分离培养出分枝杆菌40株阳性率达28.8%(40/139),经过鉴定显示其中含结核分枝杆菌(MTB)38株,占95.0%,非结核分枝杆菌(NTM)2株占5%。38株MTB对4种一线抗结核药物的耐药率为:异烟肼(INH)7.89%、利福平(RFP)10.52%、链霉素(SM)2.63%、乙胺丁醇(EMB)0.0%,总耐药率为10.52%。结论 MTB感染在南昌HIV/TB双重感染的患者中占主要比例,情况不容忽视;临床应对HIV/TB双重感染患者抗结核一线药物耐药情况重视,合理用药。