重新治疗结核病是乌干达东部农村艾滋病毒感染者中耐多药结核病的一个危险因素：一项巢式病例对照研究

IF 2 Q3 INFECTIOUS DISEASES

Journal of Clinical Tuberculosis and Other Mycobacterial Diseases Pub Date : 2025-09-12 DOI:10.1016/j.jctube.2025.100562

Godfrey Opolot , Peter Olupot-Olupot , Samuel Okware , Jonathan Izudi

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引用次数: 0

摘要

与未感染艾滋病毒的人相比，感染人类免疫缺陷病毒（PWH）的人患耐多药结核病（MDR-TB）的风险更高。目的调查乌干达东部农村妇产医院耐多药结核病的危险因素。方法我们在乌干达东部农村的Soroti地区转诊医院进行了一项巢式病例对照研究。回顾性审查2017年1月至2024年5月的结核病记录，以确定所有PWH。根据GeneXpert结核分枝杆菌和利福平试验以及基于培养的药敏试验，耐多药结核病被定义为至少对异烟肼和利福平均耐药。病例为伴有耐多药结核病的PWH，对照组为无耐多药结核病的PWH随机样本，比例为1:3。使用多变量二元逻辑回归来确定与病例而不是对照独立相关的因素。报告了校正优势比（aORs）和95%置信区间（CIs）。结果我们纳入了37例病例和111例对照，发现再治疗结核病与成为病例而不是对照相关（aOR 6.97; 95% CI 2.65-19.46）。男性（aOR: 1.59; 95% CI: 0.67-3.93）、临床诊断为肺结核（aOR: 0.38; 95% CI: 0.10-1.23）或肺外结核（aOR: 0.37; 95% CI: 0.05-1.62）和最近开始抗逆转录病毒治疗（aOR: 2.07; 95% CI: 0.83-5.28）与成为病例无显著相关。结论：本研究表明，乌干达东部农村转诊医院的PWH中结核病的再治疗与耐多药结核病的可能性较高相关。这些发现强调需要加强对既往接受过结核病治疗的PWH患者的耐药性监测和依从性支持。

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Retreatment TB is a risk factor for multidrug-resistant TB among people with HIV in rural eastern Uganda: A nested case-control study

Rationale

People with human immunodeficiency virus (PWH) have an increased risk of multidrug-resistant TB (MDR-TB) compared to those without HIV.

Objective

To investigate the risk factors for MDR-TB among PWH in rural eastern Uganda.

Methods

We conducted a nested case–control study at Soroti Regional Referral Hospital in rural eastern Uganda. TB records from January 2017 to May 2024 were retrospectively reviewed to identify all PWH. MDR-TB was defined as resistance to at least both Isoniazid and Rifampicin following GeneXpert Mycobacterium TB and Rifampicin assay and culture-based drug-susceptible testing. Cases were PWH with MDR-TB, while controls were a random sample of PWH without MDR-TB, in a 1:3 ratio. Multivariable binary logistic regression was used to identify factors independently associated with being a case rather than a control. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were reported.

Results

We included 37 cases and 111 controls, and found retreatment TB was associated with being a case rather than a control (aOR 6.97; 95% CI 2.65–19.46). Male sex (aOR: 1.59; 95% CI: 0.67–3.93), clinically diagnosed pulmonary TB (aOR: 0.38; 95% CI: 0.10–1.23) or extrapulmonary TB (aOR: 0.37; 95% CI: 0.05–1.62), and recent anti-retroviral therapy initiation (aOR: 2.07; 95% CI: 0.83–5.28) were insignificantly associated with being a case.

Conclusion

This study showed that retreatment TB is associated with a higher likelihood of MDR-TB among PWH in a referral hospital in rural eastern Uganda. These findings underscore the need for intensified drug resistance surveillance and adherence support among PWH with prior TB treatment.

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来源期刊

Journal of Clinical Tuberculosis and Other Mycobacterial Diseases Medicine-Pulmonary and Respiratory Medicine

CiteScore

4.00

自引率

5.00%

发文量

审稿时长

30 weeks

期刊介绍： Journal of Clinical Tuberculosis and Mycobacterial Diseases aims to provide a forum for clinically relevant articles on all aspects of tuberculosis and other mycobacterial infections, including (but not limited to) epidemiology, clinical investigation, transmission, diagnosis, treatment, drug-resistance and public policy, and encourages the submission of clinical studies, thematic reviews and case reports. Journal of Clinical Tuberculosis and Mycobacterial Diseases is an Open Access publication.