背景:先前的研究表明,结核病(TB)与气象因素/空气污染物之间存在关联。然而,艾滋病毒/艾滋病感染者(PLWHA)的信息很少,对结核病高度易感。
方法:2014-2020年PLWHA结核病病例数据来自广西HIV抗病毒治疗队列,中国。同期气象和大气污染物数据来源于中国气象科学数据共享服务网和广西生态环境部。使用分布滞后非线性模型(DLNM)评估了气象因素和空气污染物暴露对PLWHA结核病风险的影响。
结果:共收集了2087例新的或复发的结核病病例,具有显著的季节性和周期性分布。与中值相比,PLWHA中结核病的最大累积相对风险(RR)为0.663(95%置信区间[CI]:0.507-0.866,滞后4周),和1.478(95%CI:1.116-1.957,滞后4周),降水量增加2个单位。然而,风速和PM10均无显著的累积滞后效应。极端分析表明,热效应(RR=0.638,95CI:0.425-0.958,滞后4周),雨天效应(RR=0.285,95CI:0.135-0.599,滞后4周),无雨效应(RR=0.552,95CI:0.322-0.947,滞后4周)降低了TB的风险。此外,在CD4(+)T细胞<200细胞/微升亚组,温度,降水,PM10对结核病发病率有显著的滞后效应,而温度和降水具有显著的累积滞后效应。然而,在CD4(+)T细胞≥200个细胞/µL亚组中未观察到这些效应.
结论:对于亚热带广西的PLWHA,温度和降水对PLWHA的结核病发病率有显著的累积影响,而空气污染物影响不大。此外,气象因素对结核病发病率的影响还取决于PLWHA的免疫状态。
BACKGROUND: Previous studies have shown the association between tuberculosis (TB) and meteorological factors/air pollutants. However, little information is available for people living with HIV/AIDS (PLWHA), who are highly susceptible to TB.
METHODS: Data regarding TB cases in PLWHA from 2014 to2020 were collected from the HIV antiviral therapy cohort in Guangxi, China. Meteorological and air pollutants data for the same period were obtained from the China Meteorological Science Data Sharing Service Network and Department of Ecology and Environment of Guangxi. A distribution lag non-linear model (DLNM) was used to evaluate the effects of meteorological factors and air pollutant exposure on the risk of TB in PLWHA.
RESULTS: A total of 2087 new or re-active TB cases were collected, which had a significant seasonal and periodic distribution. Compared with the median values, the maximum cumulative relative risk (RR) for TB in PLWHA was 0.663 (95% confidence interval [CI]: 0.507-0.866, lag 4 weeks) for a 5-unit increase in temperature, and 1.478 (95% CI: 1.116-1.957, lag 4 weeks) for a 2-unit increase in precipitation. However, neither wind speed nor PM10 had a significant cumulative lag effect. Extreme analysis demonstrated that the hot effect (RR = 0.638, 95%CI: 0.425-0.958, lag 4 weeks), the rainy effect (RR = 0.285, 95%CI: 0.135-0.599, lag 4 weeks), and the rainless effect (RR = 0.552, 95%CI: 0.322-0.947, lag 4 weeks) reduced the risk of TB. Furthermore, in the CD4(+) T cells < 200 cells/µL subgroup, temperature, precipitation, and PM10 had a significant hysteretic effect on TB incidence, while temperature and precipitation had a significant cumulative lag effect. However, these effects were not observed in the CD4(+) T cells ≥ 200 cells/µL subgroup.
CONCLUSIONS: For PLWHA in subtropical Guangxi, temperature and precipitation had a significant cumulative effect on TB incidence among PLWHA, while air pollutants had little effect. Moreover, the influence of meteorological factors on the incidence of TB also depends on the immune status of PLWHA.