de Jong Bouke C, Israelski Dennis M, Corbett Elizabeth L, Small Peter M
Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California 94305, USA.
Annu Rev Med. 2004;55:283-301. doi: 10.1146/annurev.med.55.091902.103753.
Globally, the HIV and tuberculosis epidemics are stoking each other, creating a public health crisis of enormous proportions. At the level of individuals, contemporaneous infection with M. tuberculosis and HIV poses great challenges to clinical management. This chapter provides an overview of active and latent tuberculosis treatment in HIV-infected and -uninfected individuals. The discussion focuses on medication issues, including interactions between antitubercular drugs, antiretroviral drugs, and medicines used for opportunistic infections and treatment in the face of comorbidities. Clinical questions specific to coinfection are discussed, including duration and timing initiation of therapy and immune reconstitution. Most of the data presented were generated in industrialized settings and are presented to assist patient management in such settings. However, given the disproportionate amount of TB/HIV in less-developed nations and the increasing availability of antiretroviral therapy in resource-limited settings, the issues presented will become increasingly relevant globally.
在全球范围内，艾滋病毒和结核病疫情相互助长，造成了极其严重的公共卫生危机。在个体层面，同时感染结核分枝杆菌和艾滋病毒给临床管理带来了巨大挑战。本章概述了艾滋病毒感染者和未感染者中活动性和潜伏性结核病的治疗。讨论重点在于药物问题，包括抗结核药物、抗逆转录病毒药物以及用于治疗机会性感染和合并症的药物之间的相互作用。还讨论了合并感染特有的临床问题，包括治疗的持续时间和开始时机以及免疫重建。所呈现的大多数数据来自工业化国家，目的是帮助这些国家的患者管理。然而，鉴于欠发达国家中结核病/艾滋病毒感染比例过高，以及资源有限地区抗逆转录病毒疗法的可及性不断提高，所提出的问题在全球范围内将变得越来越重要。
