Epicentre, Paris, France.
Médecins Sans Frontières, London, United Kingdom.
PLoS One. 2018 Mar 8;13(3):e0193491. doi: 10.1371/journal.pone.0193491. eCollection 2018.
The emergence of resistance to anti-tuberculosis (DR-TB) drugs and the HIV epidemic represent a serious threat for reducing the global burden of TB. Although data on HIV-negative DR-TB treatment outcomes are well published, few data on DR-TB outcomes among HIV co-infected people is available despite the great public health importance.
We retrospectively reported and compared the DR-TB treatment outcomes of HIV-positive and HIV-negative patients treated with an individualized regimen based on WHO guidelines in seven countries: Abkhazia, Armenia, Colombia, Kenya, Kyrgyzstan, Swaziland and Uzbekistan.
Of the 1,369 patients started DRTB treatment, 809 (59.1%) were multi-drug resistant (MDR-TB) and 418 (30.5%) were HIV-positive. HIV-positive patients were mainly from African countries (90.1%) while HIV-negative originated from Former Soviet Union (FSU) countries. Despite a higher case fatality rate (19.0% vs 9.4%), HIV-positive MDR-TB patients had a 10% higher success rate than HIV-negative patients (64.0% vs 53.2%, p = 0.007). No difference in treatment success was found among polydrug-resistant (PDR-TB) patients. Overall, lost to follow-up rate was much higher among HIV-negative (22.0% vs. 8.4%). Older age and not receiving ART were the only factors associated with unfavorable treatment outcome among HIV-positive patients.
As already known for HIV-negative patients, success rate of DR-TB HIV-positive patients remains low and requires more effective DR-TB regimen using new drugs also suitable to HIV-infected patients on ART. The study also confirms the need of ART introduction in HIV co-infected patients.
抗结核药物耐药（DR-TB）和 HIV 流行的出现，对降低全球结核病负担构成了严重威胁。虽然关于 HIV 阴性 DR-TB 治疗结果的数据已经有很好的报道，但关于 HIV 合并感染人群的 DR-TB 结果的数据却很少，尽管这对公共卫生具有重要意义。
我们回顾性报告并比较了在七个国家（阿布哈兹、亚美尼亚、哥伦比亚、肯尼亚、吉尔吉斯斯坦、斯威士兰和乌兹别克斯坦）根据世界卫生组织指南，使用个体化方案治疗的 HIV 阳性和 HIV 阴性患者的 DR-TB 治疗结果。
在开始接受 DR-TB 治疗的 1369 名患者中，809 名（59.1%）为耐多药（MDR-TB），418 名（30.5%）为 HIV 阳性。HIV 阳性患者主要来自非洲国家（90.1%），而 HIV 阴性患者来自前苏联国家（FSU）（69.9%）。尽管 HIV 阳性 MDR-TB 患者的病死率（19.0%对 9.4%）较高，但成功率比 HIV 阴性患者高 10%（64.0%对 53.2%，p = 0.007）。在耐多药广泛耐药（PDR-TB）患者中未发现治疗成功率有差异。总体而言，HIV 阴性患者的失访率（22.0%对 8.4%）要高得多。年龄较大和未接受 ART 是 HIV 阳性患者不良治疗结局的唯一相关因素。
与 HIV 阴性患者一样，DR-TB 合并 HIV 阳性患者的治疗成功率仍然较低，需要使用适合接受 ART 的 HIV 感染患者的新药物来制定更有效的 DR-TB 方案。该研究还证实了在 HIV 合并感染患者中引入 ART 的必要性。
