Tuberculosis and Chest Service, Public Health Service Branch, Centre for Health Protection, Department of Health, Hong Kong.
Hong Kong Med J. 2013 Dec;19(6):474-83. doi: 10.12809/hkmj133937. Epub 2013 Aug 8.
To evaluate the optimal timing for initiating antiretroviral therapy in patients with human immunodeficiency virus (HIV)-associated tuberculosis in Hong Kong.
Historical cohort. SETTING. Tuberculosis and Chest Service and Special Preventive Programme, Public Health Service Branch, Centre for Health Protection, Department of Health, Hong Kong.
Consecutive patients with HIV-associated tuberculosis in a territory-wide TB-HIV registry encountered from 1996 to 2009.
Of the 260 antiretroviral therapy-naïve patients with HIV-associated tuberculosis, 32 (12%) had antiretroviral therapy initiated within 2 months after starting anti-tuberculosis treatment (early antiretroviral therapy). Early antiretroviral therapy was associated with a more favourable outcome (cure or treatment completion without relapse) at 24 months (91% vs 67%; P=0.007) than those with antiretroviral therapy started later or not initiated, and remained an independent predictor of a favourable outcome after adjustment for potential confounders. Adverse effects from anti-tuberculosis drugs tended to occur more frequently in patients with early antiretroviral therapy (13/32 or 41%) compared with the remainder (59/228 or 26%; P=0.08). A significantly higher proportion of patients in the former group experienced immune reconstitution inflammatory syndrome than in the latter group (7/32 or 22% vs 9/228 or 4%; P<0.001). There was no death attributable to immune reconstitution inflammatory syndrome.
Early initiation of antiretroviral therapy is associated with more favourable tuberculosis treatment outcomes in patients with HIV-associated tuberculosis with a low CD4 count (<200/µL). Drug co-toxicity and immune reconstitution inflammatory syndrome that may be increased by earlier initiation of antiretroviral therapy does not undermine tuberculosis treatment outcomes to a significant extent.
评估在香港，艾滋病毒（HIV）相关结核病患者中启动抗逆转录病毒治疗的最佳时机。
历史队列研究。
香港卫生署公共卫生服务处胸肺科及特别预防计划组。
在全港结核病╱HIV 注册处登记的 HIV 相关结核病患者。
在 260 名从未接受过抗逆转录病毒治疗的 HIV 相关结核病患者中，有 32 名（12%）在开始抗结核治疗后 2 个月内开始抗逆转录病毒治疗（早期抗逆转录病毒治疗）。与晚期或未开始抗逆转录病毒治疗的患者相比，早期抗逆转录病毒治疗在 24 个月时（91%与 67%；P=0.007）具有更好的结局（治愈或无复发的治疗完成），并且在调整了潜在混杂因素后仍然是良好结局的独立预测因素。早期抗逆转录病毒治疗的患者（13/32 或 41%）比其余患者（59/228 或 26%；P=0.08）更常出现抗结核药物的不良反应。与后者相比，前者中有更高比例的患者发生免疫重建炎症综合征（7/32 或 22%与 9/228 或 4%；P<0.001）。没有因免疫重建炎症综合征而导致的死亡。
在 CD4 计数（<200/µL）较低的 HIV 相关结核病患者中，早期启动抗逆转录病毒治疗与更有利的结核病治疗结局相关。抗逆转录病毒治疗早期启动可能增加的药物毒性和免疫重建炎症综合征，并没有对结核病治疗结局产生显著影响。
