Moreno Santiago, Hernández Beatriz, Dronda Fernando
Hospital Ramón y Cajal, Universidad de Alcalá, Madrid, Spain.
AIDS Rev. 2006 Jul-Sep;8(3):115-24.
Tuberculosis associated with HIV infection continues to be an important problem throughout the world. Since the advent of HAART, the medication of HIV-infected patients who have to receive concomitant treatment for tuberculosis has become a difficult task. The two main problems faced by clinicians include the significant pharmacokinetic interactions between rifamycins, a cornerstone in antituberculosis therapy, and protease inhibitors and nonnucleoside reverse transcriptase inhibitors, which are essential components of antiretroviral combination regimens, as well as the best moment to initiate antiretroviral therapy in patients with tuberculosis. The therapy of choice for patients with no previous antiretroviral experience includes an antituberculous regimen with rifampin and an efavirenz-based antiretroviral regimen. No dose adjustments of these drugs seem to be necessary. Nevirapine can be an alternative to efavirenz in this situation. For patients who cannot take efavirenz, either due to resistance or intolerance, rifabutin and a boosted protease inhibitor can be coadministered, with the necessary dose adjustments. No definite recommendations can be given regarding the optimal timing of antiretroviral therapy, but a delay of two months after initiation of antituberculosis therapy would be advisable and seems to be safe in most patients.
与HIV感染相关的结核病在全球范围内仍然是一个重要问题。自从高效抗逆转录病毒治疗（HAART）出现以来，对于必须同时接受结核病治疗的HIV感染患者进行药物治疗已成为一项艰巨任务。临床医生面临的两个主要问题包括：抗结核治疗的基石利福霉素与抗逆转录病毒联合治疗方案的重要组成部分蛋白酶抑制剂和非核苷类逆转录酶抑制剂之间存在显著的药代动力学相互作用，以及结核病患者开始抗逆转录病毒治疗的最佳时机。对于以前没有抗逆转录病毒治疗经验的患者，首选治疗方案包括含利福平的抗结核治疗方案和基于依非韦伦的抗逆转录病毒治疗方案。这些药物似乎无需调整剂量。在这种情况下，奈韦拉平可作为依非韦伦的替代药物。对于因耐药或不耐受而不能服用依非韦伦的患者，可联合使用利福布汀和增强型蛋白酶抑制剂，并进行必要的剂量调整。关于抗逆转录病毒治疗的最佳时机，尚无明确建议，但在开始抗结核治疗两个月后延迟开始抗逆转录病毒治疗是可取的，而且在大多数患者中似乎是安全的。
