Factors Associated with Negative Direct Sputum Examination in Asian and African HIV-Infected Patients with Tuberculosis (ANRS 1260) 英文参考文献.docVIP

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Factors Associated with Negative Direct Sputum Examination in Asian and African HIV-Infected Patients with Tuberculosis (ANRS 1260) 英文参考文献.doc

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Factors Associated with Negative Direct Sputum Examination in Asian and African HIV-Infected Patients with Tuberculosis (ANRS 1260) 英文参考文献

FactorsAssociatedwithNegativeDirectSputum ExaminationinAsianandAfricanHIV-InfectedPatients withTuberculosis(ANRS1260) Lo?¨cChartier1*,ChanthyLeng2,Jean-MarieSire3,OdileLeMinor1,ManilSaman2,RaymondBercion4, LilaRahalison5,ArnaudFontanet1,6,YvesGermany7,PierreL’Her8,CharlesMayaud9,MurielVray1 1Institut Pasteur, Paris, France, 2Institut Pasteur, Phnom Penh, Cambodge, 3Institut Pasteur, Dakar, Se′ne′gal, 4Ho?pital Principal, Dakar, Se′ne′gal, 5Institut Pasteur, Tananarive,Madagascar, 6Conservatoire NationaldesArtsetMe′tiers,Paris,France,7InternationalNetworkofInstitutPasteur,Paris,France,8Ho?pitalmilitaire,Percy, France,9Ho?pitalTenon,Paris,France Abstract Objective:ToidentifyfactorsassociatedwithnegativedirectsputumexaminationamongAfricanandCambodianpatients co-infectedbyMycobacteriumtuberculosisandHIV. Design:Prospectivemulticenterstudy(ANRS1260)conductedinCambodia,SenegalandCentralAfricanRepublic. Methods:Univariateandmultivariateanalyses(logisticregression)wereusedtoidentifyclinicalandradiologicalfeatures associated with negative direct sputum examination in HIV-infected patients with positive M. tuberculosis culture on Lowenstein-Jensenmedium. Results: Between September 2002 and December 2005, 175 co-infected patients were hospitalized with at least one respiratory symptom and pulmonary radiographic anomaly. Acid-fast bacillus (AFB) examination was positive in sputum samplesfrom110subjects(63%)andnegativein65patients(37%).MostpatientswereatanadvancedstageofHIVdisease (92%atstageIIIorIVoftheWHOclassification)withamedianCD4cellcountof36/mm3.Inthiscontext,wefoundthat sputum AFB negativity was more frequent in co-infected subjects with associated respiratory tract infections (OR=2.8 [95%CI:1.1–7.0]), dyspnea (OR=2.5 [95%CI:1.1–5.6]), and localized interstitial opacities (OR=3.1 [95%CI:1.3–7.6]), but was less frequent with CD4#50/mm3 (OR=0.4 [95%CI:0.2–0.90), adenopathies (OR=0.4 [95%CI:0.2–0.93]) and cavitation (OR=0.1[95%CI:0.03–0.6]). Conclusions: One novel findin