Chenyu Dong, Renfang Zhang, Shenyang Li, Jun Chen, Yunhe Liu, Xiaoqiong Xia, Gang Liu, Yinzhong Shen, Lei Liu, Liyan Zeng
{"title":"2010-2020年中国上海结核病和HIV合并感染患者治疗反应的回顾性分析","authors":"Chenyu Dong, Renfang Zhang, Shenyang Li, Jun Chen, Yunhe Liu, Xiaoqiong Xia, Gang Liu, Yinzhong Shen, Lei Liu, Liyan Zeng","doi":"10.1177/20499361241308641","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>At present, there is a need for more substantial real-world evidence on the factors influencing the effectiveness of tuberculosis (TB) treatment in HIV/TB co-infected patients.</p><p><strong>Objectives: </strong>This retrospective study aims to identify factors affecting TB treatment effectiveness in HIV/TB co-infected patients.</p><p><strong>Design: </strong>Retrospective cross-sectional study.</p><p><strong>Methods: </strong>We included 461 HIV/TB co-infected patients, deriving 742 samples based on each initial positive TB test period. A total of 7788 valid treatment records corresponding to 17 TB drug compositions and 150 clinical indicators (each > 100 records) were used for analysis. Data mining techniques were employed, including consensus clustering, Fisher's exact test, stratified analysis, multivariate logistic regression analysis, and three modeling approaches (logistic regression, support vector machine, and random forest).</p><p><strong>Results: </strong>The TB treatment effectiveness of CD4<sup>+</sup> T cell count ⩽ 42 is significantly lower than that of the sample group > 42 (aOR: 1.77, 95% CI: 1.15-2.74, <i>p</i> = 0.010). The TB treatment effectiveness of the \"rifabutin and levofloxacin alone or in combination\" group is significantly higher than that of the \"other first- and second-line anti-TB drugs in combination\" group (aOR: 0.10, 95% CI: 0.01-0.64, <i>p</i> = 0.022). Significant differences exist in factors between TB treatment effective and ineffective groups, including age (aOR: 2.12, 95% CI: 1.10-4.20, <i>p</i> = 0.027), pre-treatment high-density lipoprotein (HDL) cholesterol (aOR: 0.47, 95% CI: 0.25-0.89, <i>p</i> = 0.022), pre-treatment CD8<sup>+</sup> T cell count (aOR: 0.55, 95% CI: 0.33-0.90, <i>p</i> = 0.019), pre-treatment neutrophil percentage (aOR: 0.68, 95% CI: 0.48-0.96, <i>p</i> = 0.030), rifabutin (aOR: 1.59, 95% CI: 1.09-2.32, <i>p</i> = 0.016), and cycloserine (aOR: 0.21, 95% CI: 0.03-0.77, <i>p</i> = 0.041). The best area under the receiver operating characteristic curve of the test set under three modeling methods is 0.560-0.763. Rate of lymphocyte percentage recovering to normal is significantly higher in the TB treatment-effective group than in the treatment-ineffective group (aOR: 1.83, 95% CI: 1.09-3.10, <i>p</i> = 0.022).</p><p><strong>Conclusion: </strong>CD4<sup>+</sup> T cell count of 42/μL assists TB treatment effectiveness evaluation. Rifabutin and levofloxacin show more therapeutic benefits. Lymphocyte percentage can serve as an effective TB therapeutic and diagnostic target. Age, pre-treatment factors (HDL cholesterol, CD8<sup>+</sup> T cell count, and neutrophil percentage), rifabutin, and cycloserine are significantly associated with TB treatment effectiveness. Factors affecting TB treatment effectiveness for HIV/TB co-infected patients need more evidence.</p>","PeriodicalId":46154,"journal":{"name":"Therapeutic Advances in Infectious Disease","volume":"12 ","pages":"20499361241308641"},"PeriodicalIF":3.8000,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11851764/pdf/","citationCount":"0","resultStr":"{\"title\":\"Treatment response of patients with tuberculosis and HIV co-infection: a retrospective analysis of secondary data from Shanghai, China, 2010-2020.\",\"authors\":\"Chenyu Dong, Renfang Zhang, Shenyang Li, Jun Chen, Yunhe Liu, Xiaoqiong Xia, Gang Liu, Yinzhong Shen, Lei Liu, Liyan Zeng\",\"doi\":\"10.1177/20499361241308641\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>At present, there is a need for more substantial real-world evidence on the factors influencing the effectiveness of tuberculosis (TB) treatment in HIV/TB co-infected patients.</p><p><strong>Objectives: </strong>This retrospective study aims to identify factors affecting TB treatment effectiveness in HIV/TB co-infected patients.</p><p><strong>Design: </strong>Retrospective cross-sectional study.</p><p><strong>Methods: </strong>We included 461 HIV/TB co-infected patients, deriving 742 samples based on each initial positive TB test period. A total of 7788 valid treatment records corresponding to 17 TB drug compositions and 150 clinical indicators (each > 100 records) were used for analysis. Data mining techniques were employed, including consensus clustering, Fisher's exact test, stratified analysis, multivariate logistic regression analysis, and three modeling approaches (logistic regression, support vector machine, and random forest).</p><p><strong>Results: </strong>The TB treatment effectiveness of CD4<sup>+</sup> T cell count ⩽ 42 is significantly lower than that of the sample group > 42 (aOR: 1.77, 95% CI: 1.15-2.74, <i>p</i> = 0.010). The TB treatment effectiveness of the \\\"rifabutin and levofloxacin alone or in combination\\\" group is significantly higher than that of the \\\"other first- and second-line anti-TB drugs in combination\\\" group (aOR: 0.10, 95% CI: 0.01-0.64, <i>p</i> = 0.022). Significant differences exist in factors between TB treatment effective and ineffective groups, including age (aOR: 2.12, 95% CI: 1.10-4.20, <i>p</i> = 0.027), pre-treatment high-density lipoprotein (HDL) cholesterol (aOR: 0.47, 95% CI: 0.25-0.89, <i>p</i> = 0.022), pre-treatment CD8<sup>+</sup> T cell count (aOR: 0.55, 95% CI: 0.33-0.90, <i>p</i> = 0.019), pre-treatment neutrophil percentage (aOR: 0.68, 95% CI: 0.48-0.96, <i>p</i> = 0.030), rifabutin (aOR: 1.59, 95% CI: 1.09-2.32, <i>p</i> = 0.016), and cycloserine (aOR: 0.21, 95% CI: 0.03-0.77, <i>p</i> = 0.041). The best area under the receiver operating characteristic curve of the test set under three modeling methods is 0.560-0.763. Rate of lymphocyte percentage recovering to normal is significantly higher in the TB treatment-effective group than in the treatment-ineffective group (aOR: 1.83, 95% CI: 1.09-3.10, <i>p</i> = 0.022).</p><p><strong>Conclusion: </strong>CD4<sup>+</sup> T cell count of 42/μL assists TB treatment effectiveness evaluation. Rifabutin and levofloxacin show more therapeutic benefits. Lymphocyte percentage can serve as an effective TB therapeutic and diagnostic target. Age, pre-treatment factors (HDL cholesterol, CD8<sup>+</sup> T cell count, and neutrophil percentage), rifabutin, and cycloserine are significantly associated with TB treatment effectiveness. Factors affecting TB treatment effectiveness for HIV/TB co-infected patients need more evidence.</p>\",\"PeriodicalId\":46154,\"journal\":{\"name\":\"Therapeutic Advances in Infectious Disease\",\"volume\":\"12 \",\"pages\":\"20499361241308641\"},\"PeriodicalIF\":3.8000,\"publicationDate\":\"2025-02-24\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11851764/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Therapeutic Advances in Infectious Disease\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1177/20499361241308641\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q2\",\"JCRName\":\"INFECTIOUS DISEASES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Therapeutic Advances in Infectious Disease","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1177/20499361241308641","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}
引用次数: 0
摘要
背景：目前，对于影响HIV/TB合并感染患者结核病治疗有效性的因素，需要更多实质性的真实证据。目的：本回顾性研究旨在确定影响HIV/TB合并感染患者结核病治疗效果的因素。设计：回顾性横断面研究。方法：纳入461例HIV/TB合并感染患者，根据每个初始结核检测阳性期提取742份样本。共纳入17种结核病药物组合物的7788份有效治疗记录和150项临床指标（每项记录100条）进行分析。采用数据挖掘技术，包括共识聚类、Fisher精确检验、分层分析、多元逻辑回归分析和三种建模方法（逻辑回归、支持向量机和随机森林）。结果：CD4+ T细胞计数≥42的TB治疗效果显著低于对照组≥42 （aOR: 1.77, 95% CI: 1.15 ~ 2.74, p = 0.010）。“利福布汀与左氧氟沙星单用或联用”组的结核病治疗效果显著高于“其他一线和二线抗结核药物联用”组（aOR: 0.10, 95% CI: 0.01 ~ 0.64, p = 0.022）。TB治疗有效组和无效组之间的因素存在显著差异，包括年龄（aOR: 2.12, 95% CI: 1.10-4.20, p = 0.027）、治疗前高密度脂蛋白（HDL）胆固醇（aOR: 0.47, 95% CI: 0.25-0.89, p = 0.022）、治疗前CD8+ T细胞计数（aOR: 0.55, 95% CI: 0.33-0.90, p = 0.019）、治疗前中性粒细胞百分比（aOR: 0.68, 95% CI: 0.48-0.96, p = 0.030）、利福布汀（aOR: 1.59, 95% CI: 1.09-2.32, p = 0.016）和环丝氨酸（aOR: 0.21, 95% CI: 0.21）。0.03-0.77, p = 0.041)。三种建模方法下测试集的接收者工作特性曲线下的最佳面积为0.560-0.763。治疗有效组淋巴细胞百分率恢复正常明显高于治疗无效组（aOR: 1.83, 95% CI: 1.09 ~ 3.10, p = 0.022）。结论：CD4+ T细胞计数42/μL有助于TB治疗效果评价。利福布汀和左氧氟沙星显示出更多的治疗效果。淋巴细胞百分比可作为结核病有效的治疗和诊断指标。年龄、治疗前因素（高密度脂蛋白胆固醇、CD8+ T细胞计数和中性粒细胞百分比）、利福布汀和环丝氨酸与结核病治疗效果显著相关。影响艾滋病毒/结核病合并感染患者结核病治疗效果的因素需要更多证据。
Treatment response of patients with tuberculosis and HIV co-infection: a retrospective analysis of secondary data from Shanghai, China, 2010-2020.
Background: At present, there is a need for more substantial real-world evidence on the factors influencing the effectiveness of tuberculosis (TB) treatment in HIV/TB co-infected patients.
Objectives: This retrospective study aims to identify factors affecting TB treatment effectiveness in HIV/TB co-infected patients.
Design: Retrospective cross-sectional study.
Methods: We included 461 HIV/TB co-infected patients, deriving 742 samples based on each initial positive TB test period. A total of 7788 valid treatment records corresponding to 17 TB drug compositions and 150 clinical indicators (each > 100 records) were used for analysis. Data mining techniques were employed, including consensus clustering, Fisher's exact test, stratified analysis, multivariate logistic regression analysis, and three modeling approaches (logistic regression, support vector machine, and random forest).
Results: The TB treatment effectiveness of CD4+ T cell count ⩽ 42 is significantly lower than that of the sample group > 42 (aOR: 1.77, 95% CI: 1.15-2.74, p = 0.010). The TB treatment effectiveness of the "rifabutin and levofloxacin alone or in combination" group is significantly higher than that of the "other first- and second-line anti-TB drugs in combination" group (aOR: 0.10, 95% CI: 0.01-0.64, p = 0.022). Significant differences exist in factors between TB treatment effective and ineffective groups, including age (aOR: 2.12, 95% CI: 1.10-4.20, p = 0.027), pre-treatment high-density lipoprotein (HDL) cholesterol (aOR: 0.47, 95% CI: 0.25-0.89, p = 0.022), pre-treatment CD8+ T cell count (aOR: 0.55, 95% CI: 0.33-0.90, p = 0.019), pre-treatment neutrophil percentage (aOR: 0.68, 95% CI: 0.48-0.96, p = 0.030), rifabutin (aOR: 1.59, 95% CI: 1.09-2.32, p = 0.016), and cycloserine (aOR: 0.21, 95% CI: 0.03-0.77, p = 0.041). The best area under the receiver operating characteristic curve of the test set under three modeling methods is 0.560-0.763. Rate of lymphocyte percentage recovering to normal is significantly higher in the TB treatment-effective group than in the treatment-ineffective group (aOR: 1.83, 95% CI: 1.09-3.10, p = 0.022).
Conclusion: CD4+ T cell count of 42/μL assists TB treatment effectiveness evaluation. Rifabutin and levofloxacin show more therapeutic benefits. Lymphocyte percentage can serve as an effective TB therapeutic and diagnostic target. Age, pre-treatment factors (HDL cholesterol, CD8+ T cell count, and neutrophil percentage), rifabutin, and cycloserine are significantly associated with TB treatment effectiveness. Factors affecting TB treatment effectiveness for HIV/TB co-infected patients need more evidence.
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