| BackgroundAIDS,or Acquisition Immunodeficiency Syndrome(AIDS),is a sexually transmitted disease transmitted by the human immunodeficiency virus(HIV),and since the world’s first reported case of AIDS,about 80,000,000 HIV,more than half of those infected with HIV have caused HIV deaths.HIV/AIDS patients have reduced immune function and are prone to opportunistic infections,and lung tuberculosis is one of the most common and first opportunistic infections after HIV infection,and one of the leading causes of death in HIV/AIDS patients.HIV/AIDS combined with tuberculosis has become a major public health problem in China,and the two diseases promote and affect each other,aggravate the deterioration of the disease,and make the prognosis of patients worse.The clinical symptoms and imaging manifestations of HIV/AIDS patients with pulmonary tuberculosis are atypical,which is greatly affected by the body’s immune function,and the positive rate of conventional tuberculosis detection methods is low,which makes clinical diagnosis and treatment difficult.For the treatment of HIV/AIDS combined with pulmonary tuberculosis,WHO recommends a standard course of 6 months,and some scholars believe that there is no significant difference in the efficacy of early treatment of HIV/AIDS combined with pulmonary tuberculosis patients and HIV-negative tuberculosis patients,but some studies have proposed that extending the course of treatment can improve the anti-tuberculosis efficacy and reduce the recurrence of pulmonary tuberculosis.The course of anti-tuberculosis treatment in HIV/AIDS patients with pulmonary tuberculosis is still controversial,and there are many factors affecting the length of treatment,and there is a lack of corresponding studies in China to summarize the factors affecting the treatment course.In view of the above problems,we summarize the clinical characteristics of HIV/AIDS combined with pulmonary tuberculosis and the factors affecting the course of anti-tuberculosis treatment through retrospective research,so as to provide reference for clinical diagnosis and treatment.ObjectiveTo summarize and analyze the characteristics of clinical symptoms,imaging findings and tuberculosis etiology in HIV/AIDS patients with pulmonary tuberculosis,and explore the factors affecting the course of anti-tuberculosis treatment,so as to provide a reference for formulating the course of anti-tuberculosis treatment and predicting the efficacy of clinical HIV/AIDS patients with pulmonary tuberculosis.Method1.120 HIV/AIDS patients with pulmonary tuberculosis and 30 simple tuberculosis patients who met the enrollment conditions were screened out as the research objects,and the general baseline,clinical symptoms,imaging,etipathology of tuberculosis,anti-HIV and anti-tuberculosis treatment regimens of the patients were collected by reviewing the medical records,and their clinical characteristics were summarized.2.According to the length of anti-tuberculosis treatment,120 patients with HIV/AIDS and pulmonary tuberculosis were divided into standard course group and extended course group,the clinical characteristics of the two groups were compared,the meaningful indicators of univariate analysis were included in multivariate logistic regression,and the ROC curve was used to analyze the value of the above indicators in the evaluation of the course of treatment in patients with HIV/AIDS and pulmonary tuberculosis.Result1.Clinical characteristics of HIV/AIDS combined with pulmonary tuberculosis.1.1 120 patients with HIV/AIDS and pulmonary tuberculosis,104 males and 16females,with a median age of 42(24)years,a median length of hospitalization of29.5(29)days,27.5%of patients had low body mass index,29.2%had hypoalbuminemia,and 57.5%had multiple opportunistic infections at the same time when admission.The median count of CD4+T lymphocytes was 62.5(156)/μL,CD4+T lymphocytes<100/μL for a total of 72(60.0%)cases,100～200 CD4+T lymphocytes for a total of 19(15.8%)cases,and>200 cases/μL for a total of 29(24.2%)cases.1.2 The clinical symptoms of HIV/AIDS combined with pulmonary tuberculosis were mainly fever,cough,fever,fatigue and weight loss,while the frequency of systemic poisoning symptoms such as fever,poor feeding and weight loss was significantly higher than that of patients with simple pulmonary tuberculosis,and the difference was statistically significant(P<0.05).With the decrease of CD4+T lymphocyte number,the proportion of fever gradually increased,and the difference between groups was statistically significant(P<0.05).1.3 Imaging of HIV/AIDS patients with pulmonary tuberculosis is mainly manifested as infiltrative lesions and lymphadenopathy.With the decrease of CD4+T lymphocyte count,the proportion of imaging manifestations of lower lobar lesions,miliary lesions,and lymphadenopathy(mediastinal lymph nodes)gradually increased,and the difference between groups was statistically significant(P<0.05).HIV/AIDS patients with pulmonary tuberculosis have more lesions than 3 lung fields and even diffuse lesions in the lungs,while patients with simple pulmonary tuberculosis have more lesions that invade 2～3 lung fields,and the imaging manifestations are miliary lesions and lymphadenopathy frequency are higher than those in patients with simple pulmonary tuberculosis,and the difference is significant(P<0.05).1.4 Xpert MTB/RIF had the highest positive rate in tuberculosis primary detection,78.3%,while the positive rate of PPD test,tuberculosis DNA,acid-fast staining smear and Mycobacterium tuberculosis culture did not reach 50%.The positive rate of PPD test increased with the increase of CD4+T lymphocytes,and the difference between groups was statistically significant(P<0.001).2.Exploration of the influencing factors of anti-tuberculosis treatment course in patients with HIV/AIDS and pulmonary tuberculosis2.1 There were 100(83.3%)patients in the extended treatment group,which was significantly more than 20(16.7%)in the standard extension group.2.2 There were significant differences in the number of days of hospitalization,whether the body mass index was low,whether hypoalbuminemia and other opportunistic infections,HIV viral load,CD4+T,CD8+T lymphocyte count and ratio,C-reactive protein,procalcitonin and erythrocyte sedimentation rate in inflammatory indexes were significantly different between the two groups(P<0.05).2.3 There was no significant difference in clinical symptoms between the two groups(P>0.05);The range of imaging lesions in the extended treatment group was more than 3 lung field or intrapulmonary diffuse lesions,and the lower lobe lesions were more common,and the difference was statistically significant(P<0.05).The positive rate of PPD test in the standard treatment group was significantly higher than that in the extended treatment group,and the difference was statistically significant(P=0.001).2.4 There was no significant difference in the number of anti-TB drugs used in the intensive period of anti-HIV regimen and anti-tuberculosis treatment between the two groups(P>0.05).In the extended course group,47.0%of the patients had discontinued the first-line anti-tuberculosis drugs during the intensive period,while none of the patients in the standard treatment group had stopped the anti-tuberculosis drugs during the intensive period,and the difference between the two groups was significant(P<0.001).2.5 Low body mass index(BMI<18.5 kg/m~2),other opportunistic infections,CD4+T lymphocytes<100 cells/μL,and discontinuation of first-line anti-tuberculosis drugs during the anti-tuberculosis intensification period were independent risk factors for the need to extend the course of anti-tuberculosis(OR=3.610,10.863,19.562,16.213),and positive PPD test was an independent protective factor(OR=0.100).These five clinical indicators had good application value in the joint evaluation of the need to extend the course of anti-tuberculosis treatment(the area under the ROC curve was 0.875,95%CI 0.807～0.942,P<0.001).Conclusion1.With the decrease in the number of CD4+T lymphocytes,imaging gradually showed the following lung lobe lesions,and the proportion of miliary lesions and lymph node enlargement(mediastinal lymph node)gradually increased.2.HIV/AIDS patients with pulmonary tuberculosis,such as CD4+T lymphocytes less than 100/μL,are prone to multiple opportunistic infections,and their clinical manifestations are diverse.3.CD4+T lymphocytes<100 cells/μL,Low body mass index,other opportunistic infections,and discontinuation of first-line anti-tuberculosis drugs during the intensive period of anti-tuberculosis treatment were independent risk factors for prolonging the course of anti-tuberculosis treatment. |
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