乌干达在接受抗病毒治疗的艾滋病病人中筛查活动性结核病的一个简单工具

背景:在撒哈拉以南非洲地区,采用可靠的临床程序,对开始接受或已经接受抗病毒治疗的艾滋病病人进行活动性结核病筛查,可减少对诊断程序的需要。方法:我们对6个与结核病相关的症状和体征单独或组合在一起的效用进行了估计,并与乌干达卫生部对现患结核病(在评估抗病毒治疗资格时,作为基线)、抗病毒治疗早期(抗病毒治疗开始后的3个月内)结核病和新发结核病(抗病毒治疗3个月以后)的诊断指南进行了比较。结果:在1 995例接受抗病毒治疗资格筛查的HIV感染者中,71例(3.6%)被诊断患有结核病。对于预测活动性结核病而言,下列任一症状或体征:咳嗽≥3周,发热≥4周,淋巴结肿大或基线体质量指数≥18 kg/m^2,其灵敏度为99%(95%可信区间为96～100),特异度66%(95%可信区间为64～68),阴性预测值为100%(95%可信区间为99～100)。在抗病毒治疗随访期间,结核病发病率为2.4/100人年(95%可信区间为1.6～3.4)。出现咳嗽≥3周或全身乏力症状或体征的灵敏度为100%(95%可信区间为99～100),特异度为66%(95%可信区间为59～74),阴性预测值为100%(95%可信区间为99～100)。结论:在资源贫乏的非洲地区,应用简单的结核病筛查流程,可以准确地辨别出哪些HIV感染者需要接受进一步的结核诊断检查。

Pregnancy outcomes and risk factors for low birth weight and preterm delivery among HIV-infected pregnant women in Guangxi, China

Background Six provinces in China accounted for 70%-80% of all reported HIV/AIDS cases in the country in 2009 and five provinces accounted for 78% of all reported mother-to-child transmission （MTCT） of HIV cases. Because Guangxi belonged to both groups, the Prevention of Mother-to-Child Transmission （PMTCT） Plus program was established there to understand better low birth weight （LBW） and preterm delivery （PD） birth outcomes and their associated risk factors better. Methods Pregnancy outcomes were examined among HIV-infected pregnant women who enrolled in the PMTCT Plus program from June 2006 to February 2009 in Guangxi, China. Multivariate Logistic regression analysis was used to explore the risk factors associated with LBW （〈2500 g） and PD （gestational age 〈37 weeks）. Results The prevalence of LBW and PD among 194 HIV-positive mothers was 19.6% （38/194） and 9.8% （19/194）, respectively. Multivariate Logistic regression analysis showed that CD4 cell count 〈100 cell/IJI （multivariate-adjusted odds ratio （AOR） 5.52; 95% Cl 1.11-25.55） and CD4 cell count 100-199 cells/IJI （AOR3.40; 95% Cl 1.03-11.25, compared to CD4 cell count 〉350 cells/IJI）, gestational age 〈37 weeks （AOR 4.38; 95% Cl 1.29-14.82, compared to 〉37 weeks）, maternal weight 〈45 kg （AOR 5.64; 95% Cl 1.09-29.07） and maternal weight 45-54 kg （AOR 3.55; 95% CI 1.31-9.60, compared to 〉55 kg） at enrollment, and H IV RNA 〉100 000 copies/ml at enrollment （AOR 4.22; 95% CI 1.24-14.32） and 20 000-99 999 （AOR 2.77; 95% Cl 1.01-7.77, compared to 〈20 000 copies/ml） were associated with a higher risk of LBW. For PD, only maternal injection drug use as the route of HIV transmission （AOR 5.30; 95% Cl 1.33-21.14, compared to those infected with HIV through sexual transmission） was significantly associated with a higher risk of PD. Conclusions Lower CD4 cell count and higher HIV RNA viral load at enrollment were associated with LBW. Optimal antenatal care, including earlier antenatal screening and HIV diagnosis, is critical to earlier PMTCT prophylaxis and/or HIV treatment to prevent transmission of HIV to the infant and also to prevent LBW pregnancy outcomes.

A public health approach to rapid scale-up of free antiretroviral treatment in China： an ounce of prevention is worth a pound of cure

China＇s rapidly evolving HIV/AIDS epidemic calls for a dramatic expansion of both prevention and treatment services. Official state media recently reported that for the first time, in 2008, HIV/AIDS became China＇s leading cause of death among infectious diseases. Estimates from the Ministry of Health indicate that around 700 000 people were living with HIV and 85 000 people had AIDS in 2007. Initially, HIV-1 infection was confined primarily to certain high-risk populations such as injection drug users （IDU） along drug-trafficking routes, and former plasma donors （FPD） in rural communities in east-central China. Now, however, HIV prevalence is increasing among female sex workers （FSW） and men who have sex with men （MSM）.

Diagnosis of pulmonary tuberculosis among asymptomatic HIV＋ patients in Guangxi, China

Background Pulmonary tuberculosis （PTB） among asymptomatic Chinese patients with HIV infection has not been investigated despite high tuberculosis burden in China. This study was aimed to evaluate the prevalence, risk factors and clinical outcomes of PTB among asymptomatic patients with HIV/AIDS in Guangxi to facilitate the development of diagnostic and treatment strategies.Methods All asymptomatic adult HIV-infected patients with CD4 ＜350 cells/μl who attended four HIV clinics in Guangxi between August 2006 and March 2008 were evaluated for active PTB with physical examination, chest X-ray （CXR）,sputum smear and/or sputum liquid culture. Data were described using median （interquartile range, IQR） and frequencies.Univariate and multivariate Logistic regression analyses were performed to identify risk factors associated with PTB.Results Among 340 asymptomatic subjects, 15 （4%） were diagnosed with PTB, with 4 （27%） sputum smear positive and 8 （53%） sputum culture positive. CXR has higher diagnostic sensitivity （87%） than sputum smear （25%） and sputum culture （67%）, but lower specificity （56%） compared with sputum smear （99%） and culture （100%）. In univariate analysis,injection drug user, body mass index （BMI） ＜18 kg/m2, CD4 ＜50 cells/μl and presence of peripheral lymphadenopathy were associated with an increased risk of asymptomatic PTB, while in multivariate analysis only peripheral lymphadenopathy maintained statistical significance （OR=7.6, 95% CI 1.4-40）. Patients with negative smear and minor or no abnormalities on CXR had longer interval between screening and TB treatment.Conclusions PTB was relatively common in this group of HIV＋ asymptomatic Chinese patients. Diagnosis is challenging especially where sputum culture is unavailable. These findings suggest that an enhanced evaluation for PTB needs to be integrated with HIV care in China and transmission prevention in China to control at both households and health care facilities, especially for patients with factors associated with a higher risk of PTB.