Mohr Erika, Cox Vivian, Wilkinson Lynne, Moyo Sizulu, Hughes Jennifer, Daniels Johnny, Muller Odelia, Cox Helen
Médecins Sans Frontières (MSF), Khayelitsha, Cape Town, South Africa
Médecins Sans Frontières (MSF), Khayelitsha, Cape Town, South Africa.
Trans R Soc Trop Med Hyg. 2015 Jul;109(7):425-32. doi: 10.1093/trstmh/trv037. Epub 2015 May 15.
South Africa has high burdens of HIV, TB and drug-resistant TB (DR-TB, rifampicin-resistance). Treatment outcome data for HIV-infected versus uninfected patients is limited. We assessed the impact of HIV and other factors on DR-TB treatment success, time to culture conversion, loss-from-treatment and overall mortality after second-line treatment initiation.
A retrospective cohort analysis was conducted for patients initiated on DR-TB treatment from 2008 to 2012, within a community-based, decentralised programme in Khayelitsha, South Africa.
Among 853 confirmed DR-TB patients initiating second-line treatment, 605 (70.9%) were HIV infected. HIV status did not impact on time to sputum culture conversion nor did it impact treatment success; 48.1% (259/539) and 45.9% (100/218), respectively (p=0.59). In a multivariate model, HIV was not associated with treatment success. Death during treatment was higher among HIV-infected patients, but overall mortality was not significantly higher. HIV-infected patients with CD4 <=100 cells/ml were significantly more likely to die after starting treatment.
Response to DR-TB treatment did not differ with HIV infection in a programmatic setting with access to antiretroviral treatment (ART). Earlier ART initiation at a primary care level could reduce mortality among HIV-infected patients presenting with low CD4 counts.
南非面临着高负担的艾滋病毒、结核病和耐多药结核病（耐利福平结核病）问题。关于艾滋病毒感染患者与未感染患者的治疗结果数据有限。我们评估了艾滋病毒及其他因素对耐多药结核病治疗成功率、培养转阴时间、治疗失访率以及二线治疗开始后的总体死亡率的影响。
对2008年至2012年在南非开普敦凯伊利沙一个基于社区的分散式项目中开始接受耐多药结核病治疗的患者进行了回顾性队列分析。
在853例确诊开始二线治疗的耐多药结核病患者中，605例（70.9%）感染了艾滋病毒。艾滋病毒感染状况对痰培养转阴时间没有影响，对治疗成功率也没有影响；痰培养转阴率分别为48.1%（259/539）和45.9%（100/218）（p = 0.59）。在多变量模型中，艾滋病毒感染与治疗成功率无关。艾滋病毒感染患者治疗期间的死亡率较高，但总体死亡率没有显著升高。CD4细胞计数≤100个/毫升的艾滋病毒感染患者开始治疗后死亡的可能性显著更高。
在可获得抗逆转录病毒治疗（ART）的项目环境中，艾滋病毒感染对耐多药结核病治疗的反应没有差异。在初级保健层面更早开始抗逆转录病毒治疗可以降低CD4细胞计数低的艾滋病毒感染患者的死亡率。
