Smoking, BCG and Employment and the Risk of Tuberculosis Infection in HIV-Infected Persons in South Africa 英文参考文献.docVIP

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Smoking, BCG and Employment and the Risk of Tuberculosis Infection in HIV-Infected Persons in South Africa 英文参考文献.doc

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Smoking, BCG and Employment and the Risk of Tuberculosis Infection in HIV-Infected Persons in South Africa 英文参考文献

Smoking,BCGandEmploymentandtheRiskof TuberculosisInfectioninHIV-InfectedPersonsinSouth Africa ToluOni1,2*,HannahP.Gideon1,NonzwakaziBangani1,RelebohileTsekela1,RonnettSeldon1, KathrynWood1,KatalinA.Wilkinson1,3,ReneT.Goliath1,TomH.M.Ottenhoff4,RobertJ.Wilkinson1,2,3 1ClinicalInfectiousDiseaseResearchInitiative,InstituteofInfectiousDiseasesandMolecularMedicine,FacultyofHealthSciences,UniversityofCapeTown,CapeTown, South Africa,2DivisionofMedicine,ImperialCollegeLondon, London, UnitedKingdom,3MedicalResearchCouncil, NationalInstitute forMedical Research, London, UnitedKingdom,4LeidenUniversityMedicalCentre,Leiden,TheNetherlands Abstract Background: The increased susceptibility to latent tuberculosis infection (LTBI) of HIV-1-infected persons represents achallengeinTBepidemiccontrol.HoweverfewstudieshaveevaluatedLTBIpredictorsinageneralizedHIV/TBepidemic setting. Methods: The study recruited 335 HIV-infected participants from Khayelitsha, Cape Town between February 2008 and November2010.Tuberculinskintestsandinterferon-gammareleaseassayswereperformedonallparticipantsandactive TBexcludedusingasymptomscreen,TBmicroscopyandculture. Results: LTBIprevalencewas52.7%and61.2%(TSTandIGRArespectively).BeingarecentTBcontact(OR2.07;95%C.I. 1.15–3.69) was associated with TST positivity. Participants with a CD4.200 had a two-fold higher risk of IGRA positivity comparedtothosewithCD4counts,200(OR2.07;95%C.I.0.99–4.34).Therewasalsoa19%increaseinIGRApositivityrisk foreveryadditionalyearofschoolingandastrongassociationbetweenyearsofschoolingandemployment(p=0.0004).A decreasedriskofIGRApositivitywasobservedinpersonswithaBCGscar(OR0.46;95%C.I.0.31–0.69)andinsmokers(OR 0.47;95%C.I.0.23–0.96). Conclusion: We report the novel findings of a decreased risk of IGRA positivity in HIV-infected smokers possibly due to decreasedinterferonproduction,andinthepersonswithaBCGscarsuggestingaprotectiveroleforBCGinthispopulation. We also found an increased risk of TST positivity in employed persons,