| 1The epidemiological investigation of HIV and TB co-infectionObjective:To investigate the epidemic of HIV and the incidence of TB in different groups of people.Methods:Screening examination of HIV was performed on24326patients without TB infection and7448TB patients. Screening examination of tuberculosis was performed on67217HIV-negative and995HIV-positive hospitalized patients and2037HIV-infected patients who would like to receive combined antiviral therapy.Results:The infection rate of HIV in TB patients was0.48%, which was much higher than that in patients without TB infection (0.48%vs0.18%, P=0.000). The incidence of tuberculosis in HIV-negative hospitalized patients was0.11%, in HIV-infected patients who would like to receive combined antiviral therapy was6.38%, in hospitalized patients infected with HIV was21.01%. Incidence of tuberculosis in HIV-positive patients was much higher than that in HIV-negative patients (21.01%vs0.11%, P=0.000;6.38%vs0.11%, P=0.000). Tuberculosis is the most common opportunistic infection of AIDS, which accounted for38.0%.Conclusion:Patients with TB have a higher infection rate of HIV than patients without TB and HIV-positive patients were more likely to develop active TB than HIV-negative patients. Tuberculosis is the most common opportunistic infection of AIDS. Screening HIV in TB patients and screening TB in HIV-infected patients are important.2The clinical characteristics of HIV and TB co-infectionObjective:To investigate the clinical characteristics of HIV and TB co-infection.Methods:Three hundred and seventy-five HIV-positive TB patients and1013HIV-negative patients were included. The clinic symptoms and the TB types of HIV-positive TB patients and HIV-negative patients were analyzed.Results:The common symptoms of patients co-infected with HIV and TB were fever (85.6%), fatigue(68.4%), poor appetite(65.6%), cough (52.6%) and weight losing (50.2%). The main TB type of HIV-positive patients was pulmonary tuberculosis (51.2%), The incidence of extrapulmonary tuberculosis and miliary tuberculosis in HIV positive patients was much higher than that in HIV-negative patients (21.2%vs5.3%, P=0.000;13.3%vs1.7%, P=0.000). The CD4+T cell counts of HIV-positive EPTB patients were146(34-246) cells/ul. The CD4+T cell counts of HIV-positive patients with miliary tuberculosis were26(10-73) cells/ul. Lymphatic tuberculosis is the most common types of HIV-positive EPTB, which accounted for48.1%.Conclusion:The common symptoms of patients co-infected with HIV and TB were fever, fatigue, poor appetite, cough and weight losing, which were atypical. The main TB type of HIV-positive patients was pulmonary tuberculosis. The extrapulmonary tuberculosis and miliary tuberculosis were more common in HIV-positive patients than HIV-negative patients. Lymphatic tuberculosis is the most common types of HIV-positive EPTB.3The diagnosis of HIV and TB co-infectionObjective:To discuss the diagnostic value of imaging examination, immunological detection, bacteriology tests, bronchoscope examination and ESR for patients co-infected with HIV and TB.Methods:The imaging examination results of HIV-positive TB patients and HIV-negative TB patients were analyzed. The immunological detection, bacteriology tests, bronchoscope examination and ESR were performed on HIV-positive TB patients and HIV-negative TB patients.Results:The image features of HIV-positive TB:the lesions were diffuse (57.3%) and the mediastinal lymph nodes enlarged (52.6%). The sensitivities of IGRA, TST and TB protein chip were78.3%、16.7%and34.7%, respectively. The sensitivity of IGRA was much higher than TB protein chip and TST (78.3%vs16.7%, P=0.005;78.3%vs34.7%, P=0.000). The sensitivities of IGRA, TST and TB protein chip were influenced with the level of CD4+T cell. The sensitivity of IGRA was much higher than TST and TB protein chip when CD4+T cell counts<50cells/μl (76.6%vs14.3%, P=0.001;76.6%vs25.0%, P=0.000).32.6%HIV-positive individuals were diagnosed with LTBI by positive IGRA results. The mycobacterium tuberculosis detection rate of HIV-positive TB patients was significantly lower than HIV-negative TB patients (20.3%vs48.0%, P=0.000). The drug resistance rate of mycobacterium tuberculosis in HIV-positive TB patients was25.0%, which was similar with HIV-negative TB patients. The mycobacterium tuberculosis detection rate in patients with bronchoscope examination was much higher than patients without bronchoscope examination (51.2%vs17.7%, P=0.000). The ESR results of HIV-positive TB patients, HIV-positive patients without TB and HIV-negative TB patients were84(49-117)mm/h,53(20-83) mm/h,24(13-41) mm/h. There were significant differences among these three groups. Conclusion:The imaging examination, bronchoscope examination and ESR were useful in the diagnosis of HIV-positive TB. Compared with TB protein chip and TST, IGRA is an effective screening tool for active and latent TB in HIV-positive patients. The mycobacterium tuberculosis detection rate of HIV-positive TB patients was significantly lower than HIV-negative TB patients.4Prevalence, drugs induced hepatotoxicity and mortality among patients multi-infected with HIV, tuberculosis and hepatitis virusObjectives:To investigate the prevalence, incidence of abnormal liver function tests (LFTs) and mortality during anti-TB treatment in patients multi-infected with HIV, tuberculosis (TB) and hepatitis virus.Methods:Three hundred and sixty-one HIV-positive TB patients were enrolled and divided into the HIV/TB group, HIV/TB/HBV group and HIV/TB/HCV group. Meanwhile,1013HIV-negative TB patients were selected randomly as controls.Results:One hundred and seventeen (32.4%) HIV-positive TB patients were infected with HBV and/or HCV, compared with90(8.9%) HIV-negative TB patients (P=0.000). HIV-positive TB patients had a higher incidence of anti-tuberculosis drug-induced hepatotoxicity (DIH) than HIV-negative TB patients (4.2%vs1.0%, OR=4.348,95%CI:1.935-9.769, P=0.000). The incidence of abnormal LFTs in the HIV/TB/HBV group and HIV/TB/HCV group were significantly higher thag, in the HIV/TB group (40.7%vs11.1%, OR=5.525,95%CI:2.325-13.131, P=0.008;20.0%vs11.1%, OR=2.009,95%CI:1.057-3.820, P=0.031). A total of68.4%of patients with HBV-DNA>1.0×105copy/ml and42.9%of patients with HCV-RNA>1.0×105copy/ml had abnormal LFTs. Twenty-three (19.7%) patients multi-infected with HIV, TB and hepatitis virus were dead during anti-TB treatment.Conclusions:HIV, HBV and HCV are risk factors for the development of abnormal LFTs and mortality during anti-TB treatment. TB patients co-infected with HIV and hepatitis virus need close follow-up.5The clinical characteristics and diagnosis of HIV and NTM co-infectionObjective:To investigate the incidence and clinical characteristics of HIV and NTM co-infection.Methods:Analysis the incidence, clinical manifestation, image features and detection rate of19patients with HIV and NTM co-infection. Results:The common symptoms of patients co-infected with HIV and NTM were fever (94.7%), poor appetite (89.5%), fatigue (89.5%), weight losing (84.2%), chest distress (78.9%), cough (73.7%). The image features of HIV-positive TB:the lesions were diffuse (88.2%) and the mediastinal lymph nodes enlarged (64.7%). The detection rate of HIV-positive NTM was21.1%. HIV-positive NTM were resistant for INH, RFP, EMB, Sm, Km and Ofx.Conclusion:The clinical manifestation and the image performance of patients co-infected with HIV and NTM were similar with patients co-infected with HIV and TB. HIV-positive NTM were muti-drug resistant. The treatment of patients co-infected with HIV and NTM was a huge challenge. |
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