艾滋病毒与耐多药结核病合并感染的成人及儿童的治疗结果：系统评价与荟萃分析。

Treatment outcomes for HIV and MDR-TB co-infected adults and children: systematic review and meta-analysis.

作者信息

Isaakidis P, Casas E C, Das M, Tseretopoulou X, Ntzani E E, Ford N

机构信息

Médecins Sans Frontières, Mumbai, India; Clinical and Molecular Epidemiology Unit, Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece.

Operational Center Amsterdam, Médecins Sans Frontières, Amsterdam, The Netherlands.

出版信息

Int J Tuberc Lung Dis. 2015 Aug;19(8):969-78. doi: 10.5588/ijtld.15.0123.

DOI:10.5588/ijtld.15.0123

PMID:26162364

Abstract

BACKGROUND

The incidence of multidrug-resistant tuberculosis (MDR-TB) is increasing in high human immunodeficiency virus (HIV) prevalence settings, with high associated mortality. Treatment outcomes in HIV-co-infected adults and children are poorly documented.

OBJECTIVE

To systematically assess treatment outcomes among HIV-MDR-TB co-infected patients.

METHODS

We searched two databases and the proceedings of an annual international conference up to November 2014 for studies reporting on major clinical outcomes among HIV-MDR-TB-co-infected adults and children, and pooled the results using random-effects meta-analysis.

RESULTS

Of 4812 abstracts and articles screened, 30 studies providing data on 2578 adults and 147 children were included. Overall pooled treatment success was 56.9% (95% confidence interval [CI] 46.2-67.6), 49.9% (95%CI 38.5-61.2) among adults and 83.4% (95%CI 74.7-92) among children. Mortality was 38% in adults (95%CI 28-48.1) and 11.4% (95%CI 5.8-17.1) in children. Loss to follow-up was higher among adults (16.1%, 95%CI 9-23.2) than among children (3.9%, 95%CI 0.9-6.9). Adverse events were experienced by the majority of patients; however, this was inconsistently documented. The use of fluoroquinolones, aminoglycosides and Group IV drugs appeared to be associated with treatment success.

CONCLUSION

The proportion of HIV-MDR-TB-co-infected patients achieving treatment success was similar to success rates reported among MDR-TB patients in general, regardless of HIV status; however, mortality was higher, particularly among adults, highlighting the need for early diagnosis and more effective treatment regimens.

摘要

背景

在人类免疫缺陷病毒（HIV）高流行地区，耐多药结核病（MDR-TB）的发病率正在上升，且相关死亡率很高。关于HIV合并感染的成人和儿童的治疗结果记录较少。

目的

系统评估HIV-MDR-TB合并感染患者的治疗结果。

方法

我们检索了两个数据库以及截至2014年11月的年度国际会议论文集，以查找有关HIV-MDR-TB合并感染的成人和儿童主要临床结果的研究，并使用随机效应荟萃分析汇总结果。

结果

在筛选的4812篇摘要和文章中，纳入了30项研究，这些研究提供了2578名成人和147名儿童的数据。总体汇总治疗成功率为56.9%（95%置信区间[CI]46.2-67.6），成人中为49.9%（95%CI 38.5-61.2），儿童中为83.4%（95%CI 74.7-92）。成人死亡率为38%（95%CI 28-48.1），儿童为11.4%（95%CI 5.8-17.1）。成人失访率（16.1%，95%CI 9-23.2）高于儿童（3.9%，95%CI 0.9-6.9）。大多数患者都经历了不良事件；然而，这方面的记录并不一致。使用氟喹诺酮类、氨基糖苷类和第四组药物似乎与治疗成功有关。