Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.
J Acquir Immune Defic Syndr. 2011 Jun 1;57(2):146-52. doi: 10.1097/QAI.0b013e31821190a3.
Tuberculosis is a leading cause of morbidity and mortality worldwide. Patients with extensively drug-resistant tuberculosis (XDR-TB) have had high mortality rates, especially when coinfected with HIV.
A retrospective cohort study of the first 206 patients treated for XDR-TB in Eastern Cape Province, South Africa, October 2006 to January 2008, a province that has treated multidrug-resistant tuberculosis since 2000. All 206 patients were hospitalized for treatment until monthly sputum specimens were culture negative.
Sixty-five patients diagnosed with XDR-TB died before XDR-TB treatment start. Among 195 patients starting treatment with a known HIV status, 108 (55.4%) were HIV positive, and 86 patients (44.1%) died during the first year of treatment. HIV-positive patients receiving antiretroviral treatment (ARVs) fared and HIV-negative patients, and more of both these groups survived than HIV-positive patients not on ARVs. However, HIV-negative patients experienced more serious adverse events requiring the withdrawal of medications than did HIV-positive patients, regardless of the use of ARVs.
Experience in Eastern Cape Province, South Africa, suggests that patients can be treated for both XDR-TB and HIV. We have also shown that such combination therapy can be well tolerated by patients.
结核病是全球发病率和死亡率的主要原因。耐多药结核病（MDR-TB）患者死亡率较高，尤其是合并感染 HIV 时。
对 2006 年 10 月至 2008 年 1 月南非东开普省治疗的 206 例耐广泛药物结核病（XDR-TB）患者进行回顾性队列研究，该省自 2000 年开始治疗耐多药结核病。所有 206 例患者均住院接受治疗，直至每月痰培养阴性。
在开始 XDR-TB 治疗前，65 例诊断为 XDR-TB 的患者死亡。在已知 HIV 状态的 195 例开始接受治疗的患者中，108 例（55.4%）HIV 阳性，86 例（44.1%）在治疗的第一年死亡。接受抗逆转录病毒治疗（ARV）的 HIV 阳性患者比未接受 ARV 的 HIV 阳性患者和 HIV 阴性患者预后更好，而且这两组患者的存活人数均多于未接受 ARV 的 HIV 阳性患者。然而，无论是否使用 ARV，HIV 阴性患者经历的需要停药的严重不良事件比 HIV 阳性患者更多。
南非东开普省的经验表明，患者可以同时接受 XDR-TB 和 HIV 的治疗。我们还表明，这种联合治疗可以被患者很好地耐受。
