Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
Am J Trop Med Hyg. 2013 Jul;89(1):174-7. doi: 10.4269/ajtmh.13-0046. Epub 2013 May 13.
Treating drug-resistant tuberculosis (DR-TB) is particularly challenging in high human immunodeficiency virus (HIV) prevalence settings. Neither antiretroviral resistance testing nor viral load monitoring is widely available in sub-Saharan Africa, and antiretroviral resistance can complicate the clinical management for DR-TB/HIV coinfected patients. We describe six cases of antiretroviral resistance in DR-TB patients with HIV coinfection in Lesotho. Two patients died before or immediately after antiretroviral resistance was detected by genotyping; the remaining four patients were switched to effective antiretroviral therapy (ART) regimens. Favorable DR-TB treatment outcomes in coinfected patients require successful management of their HIV infection, including treatment with an effective ART regimen. Coinfected patients undergoing DR-TB treatment may require closer monitoring of their response to ART, including routine viral load testing, to ensure that they receive an effective ART regimen concurrent with DR-TB treatment.
在人类免疫缺陷病毒（HIV）高发地区，治疗耐多药结核病（DR-TB）尤其具有挑战性。在撒哈拉以南非洲，既没有广泛开展抗逆转录病毒耐药性检测，也没有进行病毒载量监测，而抗逆转录病毒耐药性可能会使 DR-TB/HIV 合并感染患者的临床管理复杂化。我们在莱索托描述了 6 例 DR-TB 合并 HIV 感染患者的抗逆转录病毒耐药性情况。有 2 名患者在通过基因分型检测出抗逆转录病毒耐药性之前或之后立即死亡；其余 4 名患者被转用有效的抗逆转录病毒治疗（ART）方案。合并感染患者要实现 DR-TB 的良好治疗结局，需要成功管理其 HIV 感染，包括采用有效的 ART 方案。接受 DR-TB 治疗的合并感染患者可能需要更密切监测其对 ART 的反应，包括常规进行病毒载量检测，以确保他们在接受 DR-TB 治疗的同时接受有效的 ART 方案。
