Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea.
HIV Med. 2014 Feb;15(2):77-85. doi: 10.1111/hiv.12073. Epub 2013 Aug 28.
We evaluated the effect of the time interval between the initiation of antiretroviral therapy (ART) and the initiation of tuberculosis (TB) treatment on clinical outcomes in HIV/TB-coinfected patients in an Asian regional cohort.
Adult HIV/TB-coinfected patients in an observational HIV-infected cohort database who had a known date of ART initiation and a history of TB treatment were eligible for study inclusion. The time interval between the initiation of ART and the initiation of TB treatment was categorized as follows: TB diagnosed while on ART, ART initiated ≤ 90 days after initiation of TB treatment ('early ART'), ART initiated > 90 days after initiation of TB treatment ('delayed ART'), and ART not started. Outcomes were assessed using survival analyses.
A total of 768 HIV/TB-coinfected patients were included in this study. The median CD4 T-cell count at TB diagnosis was 100 [interquartile range (IQR) 40-208] cells/μL. Treatment outcomes were not significantly different between the groups with early ART and delayed ART initiation. Kaplan-Meier analysis indicated that mortality was highest for those diagnosed with TB while on ART (3.77 deaths per 100 person-years), and the prognoses of other groups were not different (in deaths per 100 person-years: 2.12 for early ART, 1.46 for delayed ART, and 2.94 for ART not started). In a multivariate model, the interval between ART initiation and TB therapy initiation did not significantly impact all-cause mortality.
A negative impact of delayed ART in patients coinfected with TB was not observed in this observational cohort of moderately to severely immunosuppressed patients. The broader impact of earlier ART initiation in actual clinical practice should be monitored more closely.
我们评估了抗逆转录病毒疗法（ART）开始与结核病（TB）治疗开始之间的时间间隔对亚洲地区 HIV/TB 合并感染患者临床结局的影响。
在一个观察性 HIV 感染队列数据库中，纳入了已知开始接受 ART 时间且有 TB 治疗史的成年 HIV/TB 合并感染患者。ART 开始与 TB 治疗开始之间的时间间隔分为以下几类：ART 期间诊断出 TB、TB 治疗开始后 ≤90 天开始 ART（“早期 ART”）、TB 治疗开始后 >90 天开始 ART（“延迟 ART”）和未开始 ART。采用生存分析评估结局。
本研究共纳入 768 例 HIV/TB 合并感染患者。TB 诊断时的 CD4 T 细胞计数中位数为 100[四分位距（IQR）40-208]个/μL。早期 ART 和延迟 ART 组的治疗结局无显著差异。Kaplan-Meier 分析表明，在 ART 期间诊断出 TB 的患者死亡率最高（每 100 人年死亡 3.77 人），其他组的预后无差异（每 100 人年死亡人数：早期 ART 为 2.12，延迟 ART 为 1.46，未开始 ART 为 2.94）。在多变量模型中，ART 开始与 TB 治疗开始之间的间隔对全因死亡率无显著影响。
在中重度免疫抑制的观察性队列中，未观察到 TB 合并感染患者延迟 ART 带来负面影响。应更密切监测实际临床实践中更早开始 ART 的广泛影响。
