南非高 HIV 流行率患者队列中耐多药结核病（MDR-TB）的结局。
Outcomes of multi-drug resistant tuberculosis (MDR-TB) among a cohort of South African patients with high HIV prevalence.
机构信息
Johns Hopkins University School of Nursing, Baltimore, Maryland, United States of America.
出版信息
PLoS One. 2011;6(7):e20436. doi: 10.1371/journal.pone.0020436. Epub 2011 Jul 22.
BACKGROUND
Multidrug-resistant tuberculosis (MDR-TB) is a major clinical challenge, particularly in patients with human immunodeficiency virus (HIV) co-infection. MDR-TB treatment is increasingly available, but outcomes have not been well characterized. South Africa has provided MDR-TB treatment for a decade, and we evaluated outcomes by HIV status for patients enrolled between 2000 and 2004 prior to anti-retroviral access.
METHODS
We assessed treatment outcomes in a prospective cohort of patients with MDR-TB from eight provincial programs providing second line drugs. World Health Organization definitions were used. Results were stratified by HIV status.
RESULTS
Seven hundred fifty seven patients with known HIV status were included in the final analysis, and HIV infection was documented in 287 (38%). Overall, 348 patients (46.0%) were successfully treated, 74 (9.8%) failed therapy, 177 (23.4%) died and 158 (20.9%) defaulted. Patients with HIV were slightly younger and less likely to be male compared to HIV negative patients. Patients with HIV were less likely to have a successful treatment outcome (40.0 vs. 49.6; P<0.05) and more likely to die (35.2 vs. 16.2; P<0.0001). In a competing risk survival analysis, patients with HIV had a higher hazard of death (HR: 2.33, P<0.0001). Low baseline weight (less than 45 kg and less than 60 kg) was also associated with a higher hazard of death (HR: 2.52, P<0.0001; and HR: 1.50, P<0.0001, respectively, compared to weight greater than 60 kg). Weight less than 45 kg had higher risk of failure (HR: 3.58, P<0.01). Any change in treatment regimen was associated with a higher hazard of default (HR: 2.86; 95% CI 1.55-5.29, P<0.001) and a lower hazard of death (HR: 0.63, P<0.05).
CONCLUSIONS
In this MDR-TB treatment program patients with HIV infection and low weight had higher hazards of death. Overall treatment outcomes were poor. Efforts to improve treatment for MDR-TB are urgently needed.
背景
耐多药结核病（MDR-TB）是一个主要的临床挑战，尤其是在人类免疫缺陷病毒（HIV）合并感染的患者中。MDR-TB 的治疗方法越来越多，但治疗结果尚未得到很好的描述。南非已经提供了十年的 MDR-TB 治疗，我们评估了 2000 年至 2004 年期间在获得抗逆转录病毒治疗之前，通过八项省级方案接受二线药物治疗的患者的 HIV 阳性和阴性患者的治疗结果。
方法
我们评估了来自提供二线药物的八个省级方案的 MDR-TB 患者的前瞻性队列研究的治疗结果。使用世界卫生组织的定义。结果按 HIV 状态分层。
结果
757 名已知 HIV 状态的患者被纳入最终分析，287 名（38%）患者记录有 HIV 感染。总体而言，348 名患者（46.0%）成功治疗，74 名（9.8%）治疗失败，177 名（23.4%）死亡，158 名（20.9%）失访。与 HIV 阴性患者相比，HIV 阳性患者的年龄稍小，男性比例稍低。HIV 阳性患者的治疗成功率较低（40.0% vs. 49.6%；P<0.05），死亡率较高（35.2% vs. 16.2%；P<0.0001）。在竞争风险生存分析中，HIV 阳性患者死亡的风险更高（HR：2.33，P<0.0001）。基线体重较低（<45kg 和<60kg）也与死亡风险增加相关（HR：2.52，P<0.0001；HR：1.50，P<0.0001，与体重>60kg 相比）。体重<45kg 失败风险更高（HR：3.58，P<0.01）。任何治疗方案的改变都与较高的失访风险（HR：2.86；95%CI 1.55-5.29，P<0.001）和较低的死亡风险（HR：0.63，P<0.05）相关。
结论
在这个 MDR-TB 治疗方案中，HIV 感染和低体重的患者死亡风险更高。总体治疗结果较差。迫切需要努力改善 MDR-TB 的治疗。
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