在高效抗逆转录病毒治疗时代，HIV-1 感染的成年结核病患者的治疗效果得到改善。

Improved outcomes of HIV-1-infected adults with tuberculosis in the era of highly active antiretroviral therapy.

作者信息

Hung Chien-Ching, Chen Mao-Yuan, Hsiao Chin-Fu, Hsieh Szu-Min, Sheng Wang-Huei, Chang Shan-Chwen

机构信息

Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.

出版信息

AIDS. 2003 Dec 5;17(18):2615-22. doi: 10.1097/00002030-200312050-00008.

DOI:10.1097/00002030-200312050-00008

PMID:14685055

Abstract

OBJECTIVES

To compare the survival and treatment responses to antiretroviral therapy between HIV-1-infected patients with active TB (TB patients) and without (non-TB patients) in the era of highly active antiretroviral therapy (HAART).

DESIGN

8-year prospective observational study at a university hospital.

METHODS

A total of 125 (17.5%) TB patients (median CD4 cell count at TB diagnosis, 37 x 10(6) cells/l) and 591 non-TB patients (CD4 cell count at enrolment, 79 x 10(6) cells/l) were prospectively observed between June 1994 and October 2002. Virologic and immunologic responses were assessed in 230 antiretroviral-naive non-TB patients and 46 TB patients who concurrently initiated antituberculous therapy and HAART. The clinical outcome was evaluated by comparing incidence of new AIDS-associated opportunistic illnesses (OIs) and survival of all TB and non-TB patients. RESULTS Among antiretroviral-naive patients, CD4 cell count increase (71 versus 64 x 10(6) cells/l, P = 0.70) and proportions of patients achieving undetectable plasma viral load [20 of 46 versus 107 of 230, relative risk (RR), 0.93; 95% confidence interval (95% CI), 0.65-1.34; P = 0.71] at week 4 of HAART were similar between the 46 TB and 230 non-TB patients, as was the virologic failure during HAART (RR, 1.49; 95% CI, 0.92-2.41; P = 0.14). The risk for HIV progression to new OIs was also similar between the two groups (adjusted RR, 1.16; 95% CI, 0.764-1.77). The adjusted hazard ratio for death of TB patients compared with non-TB patients was 1.18 (95% CI, 0.65-2.32) before HAART era and 0.89 (95% CI, 0.57-1.69) in HAART era.

CONCLUSIONS

Our data indicated that virologic, immunologic, and clinical responses to HAART and prognosis of HIV-1-infected TB patients who were concurrently treated with antituberculous therapy and HAART were similar to those of non-TB patients.

摘要

目的

比较高效抗逆转录病毒治疗（HAART）时代，合并活动性结核病的HIV-1感染患者（结核病患者）与未合并结核病的患者（非结核病患者）接受抗逆转录病毒治疗后的生存情况及治疗反应。

设计

在一家大学医院进行的为期8年的前瞻性观察研究。

方法

1994年6月至2002年10月期间，前瞻性观察了125例（17.5%）结核病患者（结核病诊断时CD4细胞计数中位数为37×10⁶个/微升）和591例非结核病患者（入组时CD4细胞计数为79×10⁶个/微升）。对230例未接受过抗逆转录病毒治疗的非结核病患者和46例同时开始抗结核治疗及HAART的结核病患者评估病毒学和免疫学反应。通过比较所有结核病和非结核病患者新的艾滋病相关机会性感染（OIs）发病率及生存率来评估临床结局。结果在未接受过抗逆转录病毒治疗的患者中，HAART第4周时，46例结核病患者和230例非结核病患者的CD4细胞计数增加情况相似（分别为71对64×10⁶个/微升，P = 0.70），实现血浆病毒载量不可检测的患者比例也相似[46例中的20例对230例中的107例，相对危险度（RR）为0.93；95%置信区间（95%CI）为0.65 - 1.34；P = 0.71]，HAART期间的病毒学失败情况也相似（RR为1.49；95%CI为0.92 - 2.41；P = 0.14）。两组患者HIV进展为新的OIs的风险也相似（调整后RR为1.16；95%CI为0.764 - 1.77）。HAART时代之前，结核病患者与非结核病患者相比，调整后的死亡风险比为1.18（95%CI为0.65 - 2.32），在HAART时代为0.89（95%CI为0.57 - 1.69）。