Manabe Yukari C, Breen Ronan, Perti Tara, Girardi Enrico, Sterling Timothy R
Center for Tuberculosis Research, Department of Medicine, School of Medicine, The Johns Hopkins University, Baltimore, Maryland, USA.
J Infect Dis. 2009 Feb 1;199(3):437-44. doi: 10.1086/595985.
Antiretroviral therapy (ART) has beneficial effects on mortality and lowers the incidence of diseases caused by opportunistic infections, such as tuberculosis (TB). Although ART has sustained long-term benefits, the risk of TB is high during the first 3 months after ART initiation. Among cases of ART-associated TB, we define "unmasked TB" as that which occurs in patients with reactivation disease who develop clinically recognizable TB after ART with the restoration of previously acquired TB antigen-specific functional immune responses. TB cases with clinical evidence of an inflammatory syndrome are a subset of these unmasked cases, which we define as "unmasked TB-immune reconstitution inflammatory syndrome." With more widespread use of ART in areas with a high prevalence of TB, unmasked TB will likely become more common. TB diagnostics with improved sensitivity and specificity are urgently needed to detect subclinical TB before it is unmasked.
抗逆转录病毒疗法（ART）对死亡率有有益影响，并降低了由机会性感染引起的疾病的发病率，如结核病（TB）。尽管ART具有长期持续的益处，但在开始ART后的前3个月内，患结核病的风险很高。在与ART相关的结核病病例中，我们将“潜伏性结核病”定义为那些患有复发性疾病的患者在接受ART治疗后，随着先前获得的结核抗原特异性功能性免疫反应的恢复而出现临床上可识别的结核病。有炎症综合征临床证据的结核病病例是这些潜伏性病例的一个子集，我们将其定义为“潜伏性结核病-免疫重建炎症综合征”。随着ART在结核病高流行地区的更广泛使用，潜伏性结核病可能会变得更加常见。迫切需要提高敏感性和特异性的结核病诊断方法，以便在潜伏性结核病显现之前检测出亚临床结核病。
