Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa.
PLoS One. 2013;8(2):e54145. doi: 10.1371/journal.pone.0054145. Epub 2013 Feb 8.
HIV-associated tuberculosis is a common coinfection in Sub-Saharan Africa, which causes high morbidity and mortality. A sub-set of HIV-associated tuberculosis patients require prolonged hospital admission, during which antiretroviral therapy initiation may be required. The aim of this study was to document the causes of clinical deterioration of hospitalised patients with HIV-associated tuberculosis starting antiretroviral therapy in order to inform healthcare practice in low- to middle-income countries.
Prospective, observational cohort study of adult inpatients with HIV-associated tuberculosis starting antiretroviral therapy in a dedicated tuberculosis hospital in Cape Town, South Africa. Causes of clinical deterioration and outcome were recorded in the first 12 weeks of antiretroviral therapy. Patients with rifampicin-resistant tuberculosis were excluded.
Between May 2009 and November 2010, 112 patients (60% female), with a median age of 32 years were enrolled. At baseline the median CD4 count was 55 cells/mm3 (IQR 31-106) and HIV viral load 5.6 log copies/mL. All patients had significant comorbidity: 82% were bed-bound, 65% had disseminated tuberculosis and 27% had central nervous system tuberculosis. Seventy six patients (68%) developed 144 clinical events after starting antiretroviral therapy. TB-IRIS, hospital-acquired infections and significant drug toxicities occurred in 42%, 20.5% and 15% of patients respectively. A new opportunistic disease occurred in 15% of patients and a thromboembolic event in 8%. Mortality during the 12 week period was 10.6%.
High rates of TB-IRIS, hospital-acquired infections and drug toxicities complicate the course of patients with HIV-associated tuberculosis starting antiretroviral therapy in hospital. Despite the high morbidity, mortality was relatively low. Careful clinical management and adequate resources are needed in hospitalised HIV-TB patients in the 1(st) three months following ART initiation.
HIV 相关结核病是撒哈拉以南非洲地区常见的合并感染，会导致较高的发病率和死亡率。HIV 相关结核病患者中有一部分需要长期住院，在此期间可能需要开始抗逆转录病毒治疗。本研究的目的是记录开始抗逆转录病毒治疗的 HIV 相关结核病住院患者临床恶化的原因，以便为中低收入国家的医疗实践提供信息。
这是一项在南非开普敦一家专门的结核病医院进行的前瞻性、观察性队列研究，纳入了开始抗逆转录病毒治疗的 HIV 相关结核病住院成年患者。在开始抗逆转录病毒治疗的前 12 周内记录了临床恶化的原因和结局。排除了耐利福平的结核病患者。
2009 年 5 月至 2010 年 11 月，共纳入 112 例患者（60%为女性），中位年龄为 32 岁。基线时，中位 CD4 计数为 55 个细胞/mm3（IQR 31-106），HIV 病毒载量为 5.6 log 拷贝/mL。所有患者均有显著的合并症：82%卧床不起，65%患有播散性结核病，27%患有中枢神经系统结核病。76 例（68%）患者在开始抗逆转录病毒治疗后出现了 144 次临床事件。结核分枝杆菌感染后免疫重建炎症综合征（TB-IRIS）、医院获得性感染和显著药物毒性分别发生在 42%、20.5%和 15%的患者中。15%的患者出现了新的机会性疾病，8%的患者出现了血栓栓塞事件。在 12 周期间的死亡率为 10.6%。
在开始抗逆转录病毒治疗的 HIV 相关结核病住院患者中，TB-IRIS、医院获得性感染和药物毒性的发生率较高，使病程复杂化。尽管发病率较高，但死亡率相对较低。在开始 ART 后 3 个月内，HIV-TB 患者需要仔细的临床管理和充足的资源。
