Unit of Clinical Pharmacology, Faculty of Medicine, National University of Rwanda, Huye, Rwanda.
Infectious Diseases Unit, Department of Internal Medicine, Kigali University Teaching Hospital, Kigali, Rwanda ; Rwanda Biomedical Centre, Kigali, Rwanda.
J Trop Med. 2014;2014:904957. doi: 10.1155/2014/904957. Epub 2014 Jan 30.
Background. Overlapping toxicity between drugs used for HIV and TB could complicate the management of HIV/TB coinfected patients, particularly those carrying multiple opportunistic infections. This study aimed to evaluate the clinical outcomes and adverse drug events in HIV patients managed with first-line antiretroviral and first-line anti-TB drugs. Methods. This is a retrospective study utilizing medical dossiers from single-HIV infected and HIV/TB coinfected patients already initiated on ART. Predictors of outcomes included changes in CD4 cells/mm(3), body weight, physical improvement, death rate, and adverse drug reactions. Results. Records from 60 HIV patients and 60 HIV/TB patients aged between 20 and 58 years showed that all clinical indicators of effectiveness were better in single-HIV infected than in HIV/TB coinfected patients: higher CD4 cell counts, better physical improvement, and low prevalence of adverse drug events. The most frequently prescribed regimen was TDF/3TC/EFV+RHZE. The mortality rate was 20% in HIV/TB patients compared to 8.3% in the single-HIV group. Conclusion. Treatment regimens applied are efficient in controlling the progression of the infection. However, attention should be paid to adjust dosing when combining nonnucleoside antiretrovirals (EFV and NVR) with anti-TB drugs to minimize the risk of death by drug intoxication.
用于治疗 HIV 和结核病的药物存在重叠毒性,这可能会使 HIV/TB 合并感染患者的管理变得复杂,尤其是那些同时携带多种机会性感染的患者。本研究旨在评估使用一线抗逆转录病毒药物和一线抗结核药物治疗 HIV 患者的临床结局和药物不良反应。
这是一项回顾性研究,利用了已经开始接受抗逆转录病毒治疗的单重 HIV 感染和 HIV/TB 合并感染患者的医疗档案。结局的预测因素包括 CD4 细胞/mm³、体重、身体改善、死亡率和药物不良反应的变化。
60 名 HIV 患者和 60 名 HIV/TB 患者(年龄在 20 至 58 岁之间)的记录显示,所有临床疗效指标在单重 HIV 感染患者中均优于 HIV/TB 合并感染患者:CD4 细胞计数更高、身体改善更好、药物不良反应发生率较低。最常开的方案是 TDF/3TC/EFV+RHZE。HIV/TB 患者的死亡率为 20%,而单重 HIV 组为 8.3%。
所应用的治疗方案在控制感染进展方面是有效的。然而,当将非核苷类抗逆转录病毒药物(EFV 和 NVR)与抗结核药物联合使用时,应注意调整剂量,以最大程度地降低药物中毒导致死亡的风险。