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本文引用的文献

1
Immune recovery after starting ART in HIV-infected patients presenting and not presenting with tuberculosis in South Africa.南非开始抗逆转录病毒治疗的 HIV 感染者中出现和未出现结核时的免疫恢复情况。
J Acquir Immune Defic Syndr. 2013 May 1;63(1):142-5. doi: 10.1097/QAI.0b013e318288b39d.
2
Active tuberculosis is associated with worse clinical outcomes in HIV-infected African patients on antiretroviral therapy.活动性肺结核与接受抗逆转录病毒治疗的感染艾滋病毒的非洲患者的临床结局较差相关。
PLoS One. 2013;8(1):e53022. doi: 10.1371/journal.pone.0053022. Epub 2013 Jan 2.
3
Management of tuberculosis in HIV-infected patients.HIV 感染者结核病的管理。
AIDS Rev. 2012 Oct-Dec;14(4):231-46.
4
Timeliness of clinic attendance is a good predictor of virological response and resistance to antiretroviral drugs in HIV-infected patients.就诊及时性是预测 HIV 感染患者病毒学应答和抗逆转录病毒药物耐药性的一个很好的指标。
PLoS One. 2012;7(11):e49091. doi: 10.1371/journal.pone.0049091. Epub 2012 Nov 7.
5
Treatment for tuberculosis-associated immune reconstitution inflammatory syndrome in 34 HIV-infected patients.34 例 HIV 感染患者结核分枝杆菌相关性免疫重建炎症综合征的治疗。
Int J Tuberc Lung Dis. 2012 Oct;16(10):1365-70. doi: 10.5588/ijtld.11.0693.
6
β-defensin genomic copy number is associated with HIV load and immune reconstitution in sub-saharan Africans.β-防御素基因拷贝数与撒哈拉以南非洲人的 HIV 载量和免疫重建相关。
J Infect Dis. 2012 Oct 1;206(7):1012-9. doi: 10.1093/infdis/jis448. Epub 2012 Jul 26.
7
Liver enzyme abnormalities and associated risk factors in HIV patients on efavirenz-based HAART with or without tuberculosis co-infection in Tanzania.坦桑尼亚接受基于依非韦伦的高效抗逆转录病毒治疗的 HIV 患者中，合并或不合并结核分枝杆菌感染时肝酶异常及相关危险因素。
PLoS One. 2012;7(7):e40180. doi: 10.1371/journal.pone.0040180. Epub 2012 Jul 11.
8
Factors predicting discordant virological and immunological responses to antiretroviral therapy in HIV-1 clade C infected Zulu/Xhosa in South Africa.预测南非感染 HIV-1 型 C 群的祖鲁/科萨人接受抗逆转录病毒治疗时病毒学和免疫学反应不一致的因素。
PLoS One. 2012;7(2):e31161. doi: 10.1371/journal.pone.0031161. Epub 2012 Feb 14.
9
Impaired CD4 T-cell count response to combined antiretroviral therapy in antiretroviral-naive HIV-infected patients presenting with tuberculosis as AIDS-defining condition.在以结核病为艾滋病定义性疾病的初治 HIV 感染患者中，联合抗逆转录病毒治疗对 CD4 T 细胞计数反应受损。
Clin Infect Dis. 2012 Mar;54(6):853-61. doi: 10.1093/cid/cir900. Epub 2011 Dec 12.
10
Loss to follow-up and mortality among HIV-infected people co-infected with TB at ART initiation in Durban, South Africa.在南非德班，开始接受抗逆转录病毒治疗时同时感染结核的艾滋病毒感染者的随访损失和死亡率。
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结核病治疗对联合抗逆转录病毒疗法的病毒学及CD4+细胞计数反应的影响：一项系统评价

The effect of tuberculosis treatment on virologic and CD4+ cell count response to combination antiretroviral therapy: a systematic review.

作者信息

Soeters Heidi M, Napravnik Sonia, Patel Monita R, Eron Joseph J, Van Rie Annelies

机构信息

aDepartment of Epidemiology bDivision of Infectious Diseases cCenter for AIDS Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.

出版信息

AIDS. 2014 Jan 14;28(2):245-55. doi: 10.1097/01.aids.0000434936.57880.cd.

DOI:10.1097/01.aids.0000434936.57880.cd
PMID:24072197
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4512169/
Abstract

OBJECTIVE

To determine the impact of tuberculosis (TB) treatment at the time of combination antiretroviral therapy (cART) initiation on virologic and CD4 cell count response to cART.

METHODS

Systematic review and meta-analysis of studies reporting HIV RNA and CD4 cell count response, stratified by TB treatment status at cART initiation. Stratified random-effects and meta-regression analyses were used when possible.

RESULTS

Twenty-five eligible cohort studies reported data on 49 578 (range 42-15 646) adults, of whom 8826 (18%) were receiving TB treatment at cART initiation. Seventeen studies reported virologic response; 21 reported CD4 cell count response. The summarized random-effects relative risk (RRRE) of virologic suppression in those receiving vs. not receiving TB treatment at different time points following cART initiation was 1.06 (0.86-1.29) at 1-4 months, 0.91 (0.83-1.00) at 6 months, 0.99 (0.94-1.05) at 11-12 months, and 0.99 (0.77-1.28) at 18-48 months. The overall RRRE at 1-48 months was 0.97 (95% confidence interval 0.92-1.03). Available data regarding the effect of TB treatment on virologic failure were heterogeneous and inconclusive (13 estimates). Differences in median CD4 cell count gain between those receiving vs. not receiving TB treatment ranged from -10 to 60 cells/μl (median 27) by 6 months (seven estimates) and -10 to 29 (median 6) by 11-12 months (five estimates), although the heterogeneity of the response measures did not support meta-analysis.

CONCLUSION

Patients receiving TB treatment at cART initiation experience similar virologic suppression and CD4 cell count reconstitution as those not receiving TB treatment, reinforcing the need to start cART during TB treatment and allowing more confidence in clinical decision-making.

摘要

目的

确定在开始联合抗逆转录病毒治疗（cART）时进行结核病（TB）治疗对cART的病毒学应答和CD4细胞计数应答的影响。

方法

对报告HIV RNA和CD4细胞计数应答的研究进行系统评价和荟萃分析，根据cART开始时的TB治疗状态进行分层。尽可能使用分层随机效应和荟萃回归分析。

结果

25项符合条件的队列研究报告了49578名（范围42 - 15646）成年人的数据，其中8826名（18%）在开始cART时正在接受TB治疗。17项研究报告了病毒学应答；21项研究报告了CD4细胞计数应答。在开始cART后的不同时间点，接受与未接受TB治疗者的病毒学抑制汇总随机效应相对风险（RRRE）在1 - 4个月时为1.06（0.86 - 1.29），6个月时为0.91（0.83 - 1.00），11 - 12个月时为0.99（0.94 - 1.05），18 - 48个月时为0.99（0.77 - 1.28）。1 - 48个月时的总体RRRE为0.97（95%置信区间0.92 - 1.03）。关于TB治疗对病毒学失败影响的现有数据异质性较大且无定论（13项估计）。接受与未接受TB治疗者在6个月时（7项估计）CD4细胞计数增加中位数的差异范围为 - 10至60个细胞/μl（中位数27），11 - 12个月时（5项估计）为 - 10至29（中位数6），尽管应答测量的异质性不支持进行荟萃分析。

结论

在开始cART时接受TB治疗的患者与未接受TB治疗的患者经历相似的病毒学抑制和CD4细胞计数重建，这进一步证明了在TB治疗期间开始cART的必要性，并使临床决策更具信心。