Burman W, Weis S, Vernon A, Khan A, Benator D, Jones B, Silva C, King B, LaHart C, Mangura B, Weiner M, El-Sadr W
Denver Public Health and the University of Colorado Health Sciences Center, Denver, Colorado 80204, USA.
Int J Tuberc Lung Dis. 2007 Dec;11(12):1282-9.
Patients were enrolled in a prospective trial of rifabutin-based tuberculosis (TB) treatment for human immunodeficiency virus related TB. Antiretroviral therapy (ART) was encouraged, but not required.
To evaluate the frequency, risk factors and duration of immune reconstitution events.
Patients were prospectively evaluated for immune reconstitution events, and all adverse event reports were reviewed to identify possible unrecognized events.
Of 169 patients, 25 (15%) developed immune reconstitution events related to TB. All 25 were among the 137 patients who received ART during TB treatment, so the frequency in this subgroup was 18% (25/137). Risk factors for an immune reconstitution event in multivariate analysis were Black race, the presence of extra-pulmonary TB and a shorter interval from initiation of TB treatment to initiation of ART. The most common clinical manifestations were fever (64%), new or worsening adenopathy (52%) and worsening pulmonary infiltrates (40%). Twelve patients (48%) were hospitalized for a median of 7 days, six underwent surgery and 11 had needle aspiration. The median duration of events was 60 days (range 11-442).
Immune reconstitution events were common among patients receiving ART during TB treatment, produced substantial morbidity and had a median duration of 2 months.
患者参加了一项基于利福布汀的针对人类免疫缺陷病毒相关结核病的前瞻性试验。鼓励但不要求进行抗逆转录病毒治疗（ART）。
评估免疫重建事件的发生率、危险因素和持续时间。
对患者进行前瞻性免疫重建事件评估，并审查所有不良事件报告以识别可能未被认识到的事件。
169例患者中，25例（15%）发生了与结核病相关的免疫重建事件。所有25例均在137例结核病治疗期间接受ART的患者中，因此该亚组的发生率为18%（25/137）。多变量分析中免疫重建事件的危险因素为黑人种族、肺外结核病的存在以及从开始结核病治疗到开始ART的间隔时间较短。最常见的临床表现为发热（64%）、新出现或加重的淋巴结病（52%）以及肺部浸润加重（40%）。12例患者（48%）住院，中位住院时间为7天，6例接受了手术，11例进行了针吸活检。事件的中位持续时间为60天（范围11 - 442天）。
在结核病治疗期间接受ART的患者中，免疫重建事件很常见，导致了相当高的发病率，中位持续时间为2个月。
