Shin Sanghyuk S, Modongo Chawangwa, Boyd Rosanna, Caiphus Cynthia, Kuate Lesego, Kgwaadira Botshelo, Zetola Nicola M
Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, US.
Botswana-Upenn Partnership, Gaborone, Botswana.
J Acquir Immune Defic Syndr. 2017 Jan 1;74(1):65-71. doi: 10.1097/QAI.0000000000001169.
Few studies have examined multidrug-resistant (MDR) tuberculosis (TB) treatment outcomes among HIV-infected persons after widespread expansion of antiretroviral therapy (ART). We describe MDR-TB treatment outcomes among HIV-infected and HIV-uninfected patients in Botswana after ART expansion.
We retrospectively reviewed data from patients who started MDR-TB therapy in Botswana during 2006-2013. Multivariable regression models were used to compare treatment outcomes between HIV-infected and HIV-uninfected patients.
We included 588 MDR-TB patients in the analysis, of whom, 47 (8.0%) and 9 (1.5%) were diagnosed with pre-extensively drug-resistant (XDR)-TB and XDR-TB, respectively. Of the 408 (69.4%) HIV-infected patients, 352 (86.0%) were on ART or started ART during treatment, and median baseline CD4 T-cell count was 234 cells/mm. Treatment success rates were 79.4% and 73.0% among HIV-uninfected and HIV-infected patients, respectively (P = 0.121). HIV-infected patients with CD4 T-cell count <100 cells/mm were more likely to die during treatment compared with HIV-uninfected patients (adjusted risk ratio = 1.890; 95% CI: 1.098 to 3.254).
High rates of treatment success were achieved with programmatic management of MDR-TB and HIV in Botswana after widespread expansion of ART. However, a 2-fold increase in mortality was observed among HIV-infected persons with baseline CD4 <100 cells/mm compared with HIV-uninfected persons.
在抗逆转录病毒疗法（ART）广泛普及之后，很少有研究调查过HIV感染者中耐多药（MDR）结核病（TB）的治疗结果。我们描述了博茨瓦纳在ART普及之后HIV感染和未感染患者的耐多药结核病治疗结果。
我们回顾性分析了2006年至2013年期间在博茨瓦纳开始接受耐多药结核病治疗的患者的数据。采用多变量回归模型比较HIV感染和未感染患者的治疗结果。
我们纳入了588例耐多药结核病患者进行分析，其中分别有47例（8.0%）和9例（1.5%）被诊断为广泛耐药前结核病（XDR-TB）和广泛耐药结核病。在408例（69.4%）HIV感染患者中，352例（86.0%）在治疗期间接受了ART或开始接受ART，基线CD4 T细胞计数中位数为234个细胞/mm³。未感染HIV和感染HIV患者的治疗成功率分别为79.4%和73.0%（P = 0.121）。与未感染HIV的患者相比，CD4 T细胞计数<100个细胞/mm³的HIV感染患者在治疗期间死亡的可能性更大（调整风险比 = 1.890；95%置信区间：1.098至3.254）。
在博茨瓦纳广泛普及ART之后，通过耐多药结核病和HIV的规划管理实现了较高的治疗成功率。然而，与未感染HIV的人相比，基线CD4<100个细胞/mm³的HIV感染者死亡率增加了两倍。
