接受抗结核和抗逆转录病毒治疗的HIV感染患者中的结核免疫重建炎症综合征

Immune reconstitution inflammatory syndrome of tuberculosis among HIV-infected patients receiving antituberculous and antiretroviral therapy.

作者信息

Manosuthi Weerawat, Kiertiburanakul Sasisopin, Phoorisri Thanongsri, Sungkanuparph Somnuek

机构信息

Department of Medicine, Bamrasnaradura Infectious Diseases Institute, Ministry of Public Health, Tiwanon Road, Nonthaburi 11000, Thailand.

出版信息

J Infect. 2006 Dec;53(6):357-63. doi: 10.1016/j.jinf.2006.01.002. Epub 2006 Feb 17.

DOI:10.1016/j.jinf.2006.01.002

PMID:16487593

Abstract

OBJECTIVE

To determine the frequency, risk factors and mortality rate of immune reconstitution inflammatory syndrome (IRIS) of tuberculosis (TB) in patients co-infected with HIV/TB and receiving antiretroviral therapy (ART).

METHODS

A retrospective study was conducted in Bamrasnaradura Infectious Diseases Institute and Ramathibodi Hospital, Thailand.

RESULTS

There were 167 patients with a mean age of 34.5 years. Median (IQR) CD4 cell counts was 36 (15-69) cells/mm(3) and median (IQR) HIV RNA was 427,000 (189,000-750,000) copies/ml. ART was initiated at a median (IQR) duration of 2.2 (1.4-3.7) months after TB treatment. IRIS was identified in 21 (12.6%) patients. Patients with IRIS had a higher proportion of extrapulmonary TB than patients without IRIS (P<0.001). By multivariate analysis, extrapulmonary TB was a risk factor for IRIS (odds ratio=8.225, 95% confidence interval=1.785-37.911, P=0.007). Of 21 patients with IRIS, 15 patients developed IRIS within the first two months of ART. The mortality rate in patients with and without IRIS was not different (9.5% versus 2.1%, P=0.119).

CONCLUSIONS

The rate of TB IRIS is 13% in patients co-infected with HIV and TB. Extrapulmonary TB is a risk factor for IRIS. Closely monitored clinical care in the first few months of ART initiation and further interventional studies to minimize mortality of TB IRIS are needed.

摘要

目的

确定合并感染人类免疫缺陷病毒（HIV）/结核病（TB）并接受抗逆转录病毒治疗（ART）的患者中，结核病免疫重建炎症综合征（IRIS）的发生率、危险因素及死亡率。

方法

在泰国班拉史纳拉杜拉传染病研究所和拉玛提波迪医院进行一项回顾性研究。

结果

共167例患者，平均年龄34.5岁。CD4细胞计数中位数（四分位间距）为36（15 - 69）个细胞/mm³，HIV RNA中位数（四分位间距）为427,000（189,000 - 750,000）拷贝/ml。ART在结核病治疗开始后中位数（四分位间距）2.2（1.4 - 3.7）个月时启动。21例（12.6%）患者发生IRIS。发生IRIS的患者肺外结核比例高于未发生IRIS的患者（P<0.001）。多因素分析显示，肺外结核是IRIS的危险因素（比值比=8.225，95%置信区间=1.785 - 37.911，P=0.007）。21例发生IRIS的患者中，15例在ART开始的前两个月内发生IRIS。发生IRIS和未发生IRIS患者的死亡率无差异（9.5%对2.1%，P=0.119）。