合并或未合并HIV感染的患者在结核病治疗期间的矛盾反应。

Paradoxical reactions during tuberculosis treatment in patients with and without HIV co-infection.

作者信息

Breen R A M, Smith C J, Bettinson H, Dart S, Bannister B, Johnson M A, Lipman M C I

机构信息

Department of Thoracic and HIV Medicine, Royal Free Hospital, London NW3 2QG, UK.

出版信息

Thorax. 2004 Aug;59(8):704-7. doi: 10.1136/thx.2003.019224.

DOI:10.1136/thx.2003.019224

PMID:15282393

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC1747098/

Abstract

BACKGROUND

It has been suggested that deterioration of tuberculosis (TB) during appropriate treatment, termed a paradoxical reaction (PR), is more common and severe in HIV positive individuals on highly active antiretroviral therapy (HAART).

METHOD

A study was undertaken to determine the frequency of PR and its associated features in a population of HIV+TB+ patients and a similar sized group of HIV-TB+ individuals.

RESULTS

PR occurred in 28% of 50 HIV+TB+ patients and 10% of 50 HIV-TB+ patients. Disseminated TB was present in eight of 13 HIV+TB+ patients and four of five HIV-TB+ patients with PR. In 28 HIV+TB+ patients starting HAART, PR was significantly associated with commencing HAART within 6 weeks of starting antituberculosis treatment (p = 0.03) and was more common in those with disseminated TB (p = 0.09). No association was found between development of PR and baseline CD4 count or CD4 response to HAART.

CONCLUSIONS

PR is common in HIV infected and uninfected individuals with TB. Early introduction of HAART and the presence of disseminated TB appear to be important in co-infected patients.

摘要

背景

有人提出，在适当治疗期间结核病（TB）病情恶化，即所谓的矛盾反应（PR），在接受高效抗逆转录病毒治疗（HAART）的HIV阳性个体中更为常见且严重。

方法

开展了一项研究，以确定HIV+TB+患者群体以及规模相似的HIV-TB+个体群体中PR的发生频率及其相关特征。

结果

50例HIV+TB+患者中有28%出现PR，50例HIV-TB+患者中有10%出现PR。13例出现PR的HIV+TB+患者中有8例以及5例出现PR的HIV-TB+患者中有4例存在播散性结核病。在开始HAART治疗的28例HIV+TB+患者中，PR与在开始抗结核治疗后6周内开始HAART显著相关（p = 0.03），并且在患有播散性结核病的患者中更常见（p = 0.09）。未发现PR的发生与基线CD4计数或对HAART的CD4反应之间存在关联。