■分析江苏省HIV感染者(PLWH)的潜伏性结核感染(LTBI),探讨影响LTBI阳性率的因素,并采取适当措施控制结核病(TB)感染。
■于2021年6月至7月在江苏省PLWH中进行了一项横断面研究。以江苏省所有PLWH为研究人群。目前,LTBI的诊断缺乏“金标准”,只能通过免疫学方法进行。在这项研究中,结核菌素皮肤试验(TST),ESAT6-CFP10测试(EC),采用QuantiFERON-TB金管内(QFT)检测PLWH中LTBI的阳性率并分析其危险因素。
■总共包括340名囚犯,89.7%为男性,中位年龄为38岁[四分位距(IQR):32-46岁],这些患者正在接受抗病毒治疗(ART),CD4计数中位数为376(IQR:261-496),103(30.3%)在至少一项测试中呈阳性,TST的LTBI为16.5%,EC的LTBI为15.9%,QFT的LTBI为26.2%。单变量分析显示了TST的结果,EC,和QFT不受CD4计数的影响(p>0.05),和多变量分析显示,监禁史与TST阳性风险增加相关(调整后的比值比[aOR]=1.98;95%CI,1.03-3.82),EC(aOR=2.65;95%CI,1.37-5.12)和QFT(aOR=2.01;95CI,1.12-3.57),此外,女性与TST阳性(aOR=3.66;95CI,1.60-8.37)和EC(aOR=3.43;95CI,1.46-8.07)的风险增加有关,结核病患者的接触史与TST(aOR=2.54;95CI,1.23-5.22)和QFT(aOR=2.03;95CI,1.03-3.99)的风险增加有关,和少数民族(AOR=0.26;95CI,0.12-0.57),监禁时间延长与QFT阳性风险增加相关(aOR=1.12;95CI,1.02~1.24).结论女性性别,和少数民族,监禁史,监禁时间更长,结核病患者接触史是江苏省PLWH发生LTBI的危险因素,应重视该人群的结核病控制。
To analyze the latent tuberculosis infection (LTBI) among persons living with HIV(PLWH) in Jiangsu Province, to explore the factors affecting the positive rate of LTBI, and to take appropriate measures to control tuberculosis (TB) infection.
A cross-sectional study was conducted among PLWH in Jiangsu Province from June to July 2021. All PLWH in Jiangsu Province were used as the study population. Currently, the diagnosis of LTBI lacks a \"gold standard\" and can only be assisted by the immunological method. In this study, Tuberculin skin test (TST), ESAT6-CFP10 test (EC), and QuantiFERON-TB gold in-tube (QFT) were used to detect the positive rate of LTBI among PLWH and to analyze their risk factors.
A total of 340 prisoners were included, 89.7% were male, the median age was 38 years [Interquartile Range (IQR):32-46 years], these patients were on Antiviral Therapy (ART), and median CD4 counts was 376 (IQR: 261-496), 103 (30.3%) were positive in at least one test, LTBI by TST was 16.5%, LTBI by EC was 15.9%, LTBI by QFT was 26.2%. Univariate analysis showed the results for TST, EC, and QFT were not affected by CD4 counts (p>0.05), and multivariate analysis showed that a history of incarceration was associated with an increased risk of positive TST (adjusted odds ratio [aOR]=1.98;95% CI,1.03-3.82), EC (aOR=2.65;95% CI,1.37-5.12) and QFT (aOR=2.01;95%CI,1.12-3.57), in addition, female gender was associated with increased risk of positive TST (aOR=3.66;95%CI,1.60-8.37) and EC (aOR=3.43;95%CI,1.46-8.07), and contact history of TB patients was associated with increased risk of TST (aOR= 2.54;95%CI,1.23-5.22) and QFT (aOR=2.03;95%CI,1.03-3.99), and ethnic minorities (aOR=0.26;95%CI,0.12-0.57), longer duration of incarceration was associated with an increased risk of positive QFT (aOR=1.12;95%CI,1.02-1.24). Conclusions Female gender, and ethnic minorities, history of incarceration, longer duration of incarceration, and contact history of TB patients are risk factors for LTBI among PLWH in Jiangsu Province, and attention should be paid to TB control in this population.