Clinical Infectious Diseases Research Initiative, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Observatory 7925, Republic of South Africa.
Department of Medicine, Imperial College London, London W2 1PG and The Francis Crick Institute Mill Hill Laboratory, London NW7 1AA, United Kingdom.
Microbiol Spectr. 2016 Dec;4(6). doi: 10.1128/microbiolspec.TBTB2-0012-2016.
The modulation of tuberculosis (TB)-induced immunopathology caused by human immunodeficiency virus (HIV)-1 coinfection remains incompletely understood but underlies the change seen in the natural history, presentation, and prognosis of TB in such patients. The deleterious combination of these two pathogens has been dubbed a "deadly syndemic," with each favoring the replication of the other and thereby contributing to accelerated disease morbidity and mortality. HIV-1 is the best-recognized risk factor for the development of active TB and accounts for 13% of cases globally. The advent of combination antiretroviral therapy (ART) has considerably mitigated this risk. Rapid roll-out of ART globally and the recent recommendation by the World Health Organization (WHO) to initiate ART for everyone living with HIV at any CD4 cell count should lead to further reductions in HIV-1-associated TB incidence because susceptibility to TB is inversely proportional to CD4 count. However, it is important to note that even after successful ART, patients with HIV-1 are still at increased risk for TB. Indeed, in settings of high TB incidence, the occurrence of TB often remains the first presentation of, and thereby the entry into, HIV care. As advantageous as ART-induced immune recovery is, it may also give rise to immunopathology, especially in the lower-CD4-count strata in the form of the immune reconstitution inflammatory syndrome. TB-immune reconstitution inflammatory syndrome will continue to impact the HIV-TB syndemic.
人类免疫缺陷病毒（HIV）-1 合并感染导致的结核病（TB）免疫病理学的调节机制仍不完全清楚，但它是导致此类患者的 TB 自然史、表现和预后发生变化的基础。这两种病原体的有害组合被称为“致命综合征”，它们相互促进复制，从而导致疾病发病率和死亡率加速上升。HIV-1 是发展为活动性结核病的最佳公认危险因素，占全球病例的 13%。联合抗逆转录病毒疗法（ART）的出现大大降低了这种风险。ART 在全球范围内的快速推出，以及世界卫生组织（WHO）最近建议对任何 CD4 细胞计数的所有 HIV 感染者启动 ART，应该会进一步降低 HIV-1 相关 TB 的发病率，因为对 TB 的易感性与 CD4 计数成反比。然而，值得注意的是，即使在成功接受 ART 后，HIV-1 感染者仍面临更高的 TB 风险。事实上，在 TB 发病率较高的环境中，TB 的发生往往仍然是 HIV 护理的首次表现，从而进入 HIV 护理。尽管 ART 诱导的免疫恢复具有优势，但它也可能引发免疫病理学，特别是在 CD4 计数较低的人群中，表现为免疫重建炎症综合征。TB-免疫重建炎症综合征将继续影响 HIV-TB 综合征。
