Dautzenberg B, Truffot C, Mignon A, Rozenbaum W, Katlama C, Perronne C, Parrot R, Grosset J
Service de Pneumologie, Groupe Hospitalier Pitié Salpêtriere, Paris, France.
Tubercle. 1991 Sep;72(3):168-75. doi: 10.1016/0041-3879(91)90002-a.
96 AIDS patients with fever and either acid-fast bacilli on microscopic examination of bacteriological samples or mycobacteria isolated by culture were treated with a daily 4-drug combination of 7-10 mg/kg rifabutin, 5 mg/kg isoniazid, 20 mg/kg ethambutol and 100 mg clofazimine. 46 patients were excluded from efficacy assessment: 13 died before or within the first days of treatment, 5 had negative initial cultures, 14 had initial cultures positive for M. tuberculosis, 4 for M. kansasii, 1 for M. flavescens, 1 for M. gordonae, 7 were lost to follow-up and 1 received no rifabutin. In the 50 remaining patients, 31 had disseminated disease due to M. avium intracellulare complex (MAIC) and 19 had apparently localised disease, due to MAIC in 15 cases and to M. xenopi in 4 cases. Side-effects led to withdrawal of isoniazid in 1 case (hepatic enzymes increased) and rifabutin in another (thrombocytopenia). After 1 month of treatment, fever decreased from 38.4 +/- 0.6 degrees C to 37.7 +/- 0.5 degrees C (p less than 0.01) and patients stopped losing weight. After 3 months treatment, only 37 patients were alive and still under treatment. Cultures became negative in 16 of 23 patients with available bacteriological data (9 of 14 patients with disseminated disease and 7 of 9 patients with localised disease), relapse occurred before death in 4 patients. 34 patients died before treatment was completed. Death was considered to be related to mycobacterial infection in 5 cases. We conclude that the 4-drug combination is safe and, in some cases, it appears to be effective.
96例艾滋病患者出现发热，且细菌学样本显微镜检查发现抗酸杆菌或培养分离出分枝杆菌，接受了每日一次的四联药物治疗，药物组合为：利福布汀7 - 10mg/kg、异烟肼5mg/kg、乙胺丁醇20mg/kg及氯法齐明100mg。46例患者被排除在疗效评估之外：13例在治疗前或治疗头几天内死亡，5例初始培养结果为阴性，14例初始培养结果为结核分枝杆菌阳性，4例为堪萨斯分枝杆菌阳性，1例为微黄分枝杆菌阳性，1例为戈登分枝杆菌阳性，7例失访，1例未接受利福布汀治疗。在其余50例患者中，31例患有鸟分枝杆菌胞内复合群（MAIC）引起的播散性疾病，19例患有明显的局限性疾病，其中15例由MAIC引起，4例由偶发分枝杆菌引起。副作用导致1例（肝酶升高）停用异烟肼，另1例（血小板减少）停用利福布汀。治疗1个月后，体温从38.4±0.6摄氏度降至37.7±0.5摄氏度（p<0.01），患者停止体重减轻。治疗3个月后，仅37例患者存活且仍在接受治疗。在有可用细菌学数据的23例患者中，16例培养结果转为阴性（14例播散性疾病患者中的9例和9例局限性疾病患者中的7例）；4例患者在死亡前复发。34例患者在治疗完成前死亡。5例死亡被认为与分枝杆菌感染有关。我们得出结论，该四联药物组合是安全的，在某些情况下似乎有效。
