Institute of Thoracic Diseases, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
Int J Tuberc Lung Dis. 2013 Feb;17(2):192-7. doi: 10.5588/ijtld.11.0831.
Antiretroviral therapy (ART) significantly reduces tuberculosis (TB) incidence among persons with human immunodeficiency virus (HIV), but the safety and effectiveness of concomitant treatment for both diseases remain unclear.
To evaluate the impact of ART and anti-tuberculosis treatment on survival and risk of adverse events (AE) among co-infected individuals.
In a retrospective cohort study, clinical data were collected from 618 TB-HIV patients treated with rifampin, isoniazid and pyrazinamide ± ethambutol between 1 January 1995 and 31 December 2003. Patients were categorized into two groups: highly active ART (HAART) or no ART. Different HAART regimens were evaluated. Bivariate analysis, multivariate logistic regression and survival analysis using Cox proportional hazards regression were used.
One-year mortality was lower for patients receiving HAART (adjusted hazard ratio [aHR] 0.17, 95%CI 0.09-0.31) compared to no ART. HAART increased the risk of AE (aHR 2.08, 95%CI 1.29-3.36). The odds of AE when receiving a ritonavir + saquinavir HAART regimen was eight-fold higher compared to no ART (OR 8.31, 95%CI 3.04-22.69), while efavirenz-based HAART was not associated with a significantly increased risk of AE (OR 1.42, 95%CI 0.76-2.65).
HIV patients with TB have significantly better survival if they receive HAART during anti-tuberculosis treatment. Efavirenz-based HAART is associated with fewer AEs than protease inhibitor-based HAART.
抗逆转录病毒疗法（ART）可显著降低人类免疫缺陷病毒（HIV）感染者的结核病（TB）发病率，但同时治疗这两种疾病的安全性和有效性仍不清楚。
评估 ART 和抗结核治疗对合并感染个体的生存和不良事件（AE）风险的影响。
在一项回顾性队列研究中，从 1995 年 1 月 1 日至 2003 年 12 月 31 日期间接受利福平、异烟肼和吡嗪酰胺±乙胺丁醇治疗的 618 例 TB-HIV 患者中收集临床数据。患者分为两组：高效抗逆转录病毒治疗（HAART）或无 ART。评估了不同的 HAART 方案。采用双变量分析、多变量逻辑回归和 Cox 比例风险回归进行生存分析。
与无 ART 相比，接受 HAART 的患者的 1 年死亡率较低（调整后的危险比 [aHR] 0.17，95%CI 0.09-0.31）。HAART 增加了 AE 的风险（aHR 2.08，95%CI 1.29-3.36）。与无 ART 相比，接受利托那韦+沙奎那韦 HAART 方案的患者发生 AE 的几率高 8 倍（OR 8.31，95%CI 3.04-22.69），而依非韦伦为基础的 HAART 与 AE 风险的显著增加无关（OR 1.42，95%CI 0.76-2.65）。
在抗结核治疗期间接受 HAART 的 HIV 合并结核病患者的生存状况显著改善。与基于蛋白酶抑制剂的 HAART 相比，基于依非韦伦的 HAART 与较少的 AE 相关。
