Division of Infectious Diseases, Department of Medicine, Alpert Medical School, Brown University/Miriam Hospital, Providence, RI, USA.
Drugs. 2011 Jun 18;71(9):1133-52. doi: 10.2165/11591360-000000000-00000.
Globally, tuberculosis (TB) and HIV interact in deadly synergy. The high burden of TB among HIV-infected individuals underlies the importance of TB diagnosis, treatment and prevention for clinicians involved in HIV care. Despite expanding access to antiretroviral therapy (ART) to treat HIV infection in resource-limited settings, many individuals in need of therapy initiate ART too late and have already developed clinically significant TB by the time they present for care. Many co-infected individuals are in need of concurrent ART and anti-TB therapy, which dramatically improves survival, but also raises several management challenges, including drug interactions, shared drug toxicities and TB immune reconstitution inflammatory syndrome (IRIS). Due to the survival benefits of promptly initiating ART among all HIV-infected individuals, including those with TB, it is recommended that co-infected individuals receive treatment for both diseases, regardless of CD4+ cell count. We review current screening and treatment strategies for TB and HIV co-infection. Recent findings and ongoing studies will assist clinicians in managing the prevention and treatment of TB and HIV co-infection, which remains a major global health challenge.
在全球范围内，结核病（TB）和 HIV 相互作用，形成致命的协同作用。HIV 感染者中结核病负担沉重，这凸显了结核病诊断、治疗和预防对于参与 HIV 护理的临床医生的重要性。尽管在资源有限的环境中扩大了获得抗逆转录病毒疗法（ART）治疗 HIV 感染的机会，但许多需要治疗的人接受 ART 的时间太晚，在寻求治疗时已经出现了具有临床意义的结核病。许多合并感染的人需要同时接受 ART 和抗结核治疗，这显著提高了生存率，但也带来了一些管理挑战，包括药物相互作用、共同药物毒性和结核免疫重建炎症综合征（IRIS）。由于及时为所有 HIV 感染者（包括结核病患者）启动 ART 可带来生存获益，因此建议合并感染的人接受两种疾病的治疗，无论 CD4+细胞计数如何。我们回顾了结核病和 HIV 合并感染的现行筛查和治疗策略。最近的发现和正在进行的研究将帮助临床医生管理结核病和 HIV 合并感染的预防和治疗，这仍然是一个主要的全球卫生挑战。
