Pontali Emanuele, Sotgiu Giovanni, Centis Rosella, D'Ambrosio Lia, Spanevello Antonio, Migliori Giovanni Battista
a Department of Infectious Diseases , Galliera Hospital, Mura delle Cappuccina, 14 , 16128 Genova , Italy.
b Clinical Epidemiology and Medical Statistics Unit, Department of Biomedical Sciences , University of Sassari - Research, Medical Education and Professional Development Unit, AOU Sassari, via Padre Manzella, 4 , 07100 , Sassari , Italy.
Expert Opin Pharmacother. 2015;16(18):2737-50. doi: 10.1517/14656566.2015.1100169. Epub 2015 Oct 19.
Multidrug-resistant and extensively drug-resistant tuberculosis (MDR- and XDR-TB) are major public health concerns worldwide. Their association with HIV/AIDS infection has contributed to the slowing down of TB incidence decline over the last two decades, therefore representing one of the most important barriers to reach TB elimination.
The aim of this manuscript is to critically review the recent scientific evidence on the management of drug-resistant TB (essentially MDR- and XDR-TB) in subjects coinfected with HIV, focusing on the two new recently-approved anti-TB drugs delamanid and bedaquiline. The medical search-engine PubMed was used, selecting the time-period January 2013 - February 2015, and using the following
drug-resistant TB, multidrug resistant TB (or MDR-TB), extensively drug-resistant TB (or XDR-TB), delamanid and bedaquiline.
The TB/HIV co-epidemic can be faced by implementing the 12 TB/HIV collaborative activities recommended by the World Health Organization. They are focused on the systematic screening of individuals to detect the Mycobacterium tuberculosis infection in HIV-positives, as well as HIV infection in TB patients in order to ensure a rapid initiation of the anti-retroviral therapy (ART). The clinical and public health management of HIV-positive individuals with MDR-TB is complex and expensive, given the cost of second line anti-TB drugs (including the new drugs, delamanid and bedaquiline) and ART. Political commitment and more investment to identify shorter, cheaper and effective anti-TB and HIV regimens as well as better diagnostics and, hopefully, a vaccine will contribute to boost the efforts to eliminate TB.
耐多药和广泛耐药结核病（MDR-TB和XDR-TB）是全球主要的公共卫生问题。在过去二十年中，它们与艾滋病毒/艾滋病感染的关联导致结核病发病率下降放缓，因此成为实现结核病消除的最重要障碍之一。
本手稿的目的是批判性地回顾近期关于艾滋病毒合并感染患者中耐药结核病（主要是MDR-TB和XDR-TB）管理的科学证据，重点关注两种最近批准的新型抗结核药物地拉曼尼和贝达喹啉。使用医学搜索引擎PubMed，选择2013年1月至2015年2月的时间段，并使用以下关键词：耐药结核病、耐多药结核病（或MDR-TB）、广泛耐药结核病（或XDR-TB）、地拉曼尼和贝达喹啉。
可以通过实施世界卫生组织推荐的12项结核病/艾滋病毒合作活动来应对结核病/艾滋病毒合并流行。这些活动侧重于对个体进行系统筛查，以检测艾滋病毒阳性者中的结核分枝杆菌感染，以及结核病患者中的艾滋病毒感染，以确保迅速启动抗逆转录病毒疗法（ART）。鉴于二线抗结核药物（包括新药地拉曼尼和贝达喹啉）和ART的成本，对MDR-TB艾滋病毒阳性个体的临床和公共卫生管理既复杂又昂贵。政治承诺以及更多投资以确定更短、更便宜且有效的抗结核和艾滋病毒治疗方案，以及更好的诊断方法，并有望研发出疫苗，将有助于推动消除结核病的努力。
