Sara Chandy, Elsa Heylen, Baijayanti Mishra, Lennartsdotter Ekstrand Maria
Department of Medicine, St John's Medical College, Bangalore, India.
Center for AIDS Prevention Studies, University of California, San Francisco, USA.
World J AIDS. 2016 Sep;6(3):87-100. doi: 10.4236/wja.2016.63013. Epub 2016 Sep 9.
To examine demographics, clinical correlates, sputum AFB (acid fast bacilli) smear grading DOTS (Directly Observed Therapy Short Course) uptake, and drug resistance in a cohort of newly-diagnosed, smear positive pulmonary tuberculosis (TB) patients with respect to HIV status at baseline, and compare smear conversion rates, side effects and mortality after two months.
A prospective study among 54 HIV positive and 41 HIV negative pulmonary TB patients. Data were collected via face-to-face interviews, review of medical records, and lab tests.
HIVTB co-infected patients, though more symptomatic at baseline, showed more improvement in their symptoms compared to HIV-uninfected TB patients at follow-up. The HIV co-infected group had more prevalent perceived side effects, and sputum smear positivity was marginally higher compared to the HIV negative group at follow-up. Mortality was higher among the HIV-infected group. Both groups had high rates of resistance to first-line anti-tubercular drugs, particularly isoniazid. There was no significant difference in the drug resistance patterns between the groups.
Prompt initiation and provision of daily regimens of ATT (Anti-Tubercular treatment) along with ART (Anti-Retroviral treatment) via ART centers is urgently needed in India. As resistance to ART and/or ATT is directly linked to medication non-adherence, the use of counseling, regular reinforcement, early detection and appropriate intervention strategies to tackle this complex issue could help prevent premature mortality and development of resistance in HIV-TB co-infected patients. The high rate of isoniazid resistance might preclude its use in India as prophylaxis for latent TB in HIV infected persons as per the World Health Organization (WHO) guideline.
研究一组新诊断的涂片阳性肺结核患者的人口统计学特征、临床相关性、痰抗酸杆菌涂片分级、短程直接观察治疗（DOTS）的接受情况以及基线时的HIV感染状况与耐药性，并比较两个月后的涂片转阴率、副作用和死亡率。
对54例HIV阳性和41例HIV阴性肺结核患者进行前瞻性研究。通过面对面访谈、病历审查和实验室检查收集数据。
HIV合并结核感染的患者虽然在基线时症状更多，但与未感染HIV的结核患者相比，随访时症状改善更明显。HIV合并感染组的副作用感知更为普遍，随访时痰涂片阳性率略高于HIV阴性组。HIV感染组的死亡率更高。两组对一线抗结核药物的耐药率都很高，尤其是异烟肼。两组之间的耐药模式没有显著差异。
印度迫切需要通过抗逆转录病毒治疗中心迅速启动并提供抗结核治疗（ATT）的每日治疗方案以及抗逆转录病毒治疗（ART）。由于对ART和/或ATT的耐药性与药物不依从直接相关，使用咨询、定期强化、早期检测和适当的干预策略来解决这一复杂问题，可能有助于预防HIV合并结核感染患者过早死亡和耐药性的发展。根据世界卫生组织（WHO）的指南，异烟肼的高耐药率可能使其无法在印度用于HIV感染者潜伏性结核的预防。
