Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York 10467, USA.
Int J Tuberc Lung Dis. 2012 Jan;16(1):90-7. doi: 10.5588/ijtld.11.0153.
Recent studies suggest that the prevalence of drug-resistant tuberculosis (TB) in sub-Saharan Africa may be rising. This is of concern, as human immunodeficiency virus (HIV) co-infection in multidrug-resistant (MDR) and extensively drug-resistant (XDR) TB has been associated with exceedingly high mortality rates.
To identify risk factors associated with mortality in MDR- and XDR-TB patients co-infected with HIV in South Africa.
Case-control study of patients who died of all causes within 2 years of diagnosis with MDR- or XDR-TB.
Among 123 MDR-TB patients, 78 (63%) died following diagnosis. CD4 count ≤ 50 (HR 4.64, P = 0.01) and 51-200 cells/mm(3) (HR 4.17, P = 0.008) were the strongest independent risk factors for mortality. Among 139 XDR-TB patients, 111 (80%) died. CD4 count ≤ 50 cells/mm(3) (HR 4.46, P = 0.01) and resistance to all six drugs tested (HR 2.54, P = 0.04) were the principal risk factors. Use of antiretroviral therapy (ART) was protective (HR 0.34, P = 0.009).
Mortality due to MDR- and XDR-TB was associated with greater degree of immunosuppression and drug resistance. Efforts to reduce mortality must focus on preventing the amplification of resistance by strengthening TB treatment programs, as well as reducing the pool of immunosuppressed HIV-infected patients through aggressive HIV testing and ART initiation.
最近的研究表明，撒哈拉以南非洲地区耐多药结核病（TB）的流行率可能正在上升。这令人担忧，因为人类免疫缺陷病毒（HIV）合并感染在耐多药（MDR）和广泛耐药（XDR）结核病中与极高的死亡率相关。
确定南非 HIV 合并感染 MDR 和 XDR-TB 患者死亡的相关危险因素。
对 MDR 或 XDR-TB 确诊后 2 年内因各种原因死亡的患者进行病例对照研究。
在 123 例 MDR-TB 患者中，78 例（63%）在确诊后死亡。CD4 计数≤50 个细胞/立方毫米（HR 4.64，P=0.01）和 51-200 个细胞/立方毫米（HR 4.17，P=0.008）是死亡的最强独立危险因素。在 139 例 XDR-TB 患者中，111 例（80%）死亡。CD4 计数≤50 个细胞/立方毫米（HR 4.46，P=0.01）和对所有六种测试药物的耐药性（HR 2.54，P=0.04）是主要的危险因素。抗逆转录病毒治疗（ART）的使用具有保护作用（HR 0.34，P=0.009）。
MDR 和 XDR-TB 导致的死亡率与免疫抑制程度和耐药程度增加有关。降低死亡率的努力必须集中于通过加强结核病治疗项目来防止耐药性的扩大，以及通过积极进行 HIV 检测和启动 ART 来减少免疫抑制的 HIV 感染患者人数。
