Center for Strategic Studies, Fiocruz and Instituto de Doenças do Torax Federal University of Rio de Janeiro, UFRJ.
Evandro Chagas National Institute of Infectious Diseases - Fiocruz, Rio de Janeiro, Brazil.
Curr Opin HIV AIDS. 2018 Nov;13(6):507-511. doi: 10.1097/COH.0000000000000504.
Tuberculosis (TB) remains the leading cause of death in people living with HIV (PLHIV) despite the achievements in antiretroviral therapy coverage. TB preventive therapy (TPT) has proved efficacy but has been neglected and poorly implemented. We reviewed recent publications and guidelines about TPT in PLHIV.
High-quality studies showed that TPT has a durable effect, over 5 years, preventing TB and all-cause mortality. There is new evidence showing the noninferiority of shorter, rifamycin-based regimens of TPT increasing the options for treatment. Recent studies describing robust implementation in different settings showed promising results for feasibility, tolerance, retention, and cost-effectiveness. New WHO recommendations, unifying previous versions, have been released to guide countries implementation.
New evidence support the scale up of TPT for PLHIV globally, further studies are needed to bring more evidence for specific populations, like pregnant women and for drug-drug interactions with antiretroviral agents.
尽管抗逆转录病毒治疗的覆盖面取得了成就，但结核病（TB）仍然是艾滋病毒感染者（PLHIV）死亡的主要原因。结核预防治疗（TPT）已被证明有效，但却被忽视且实施不力。我们回顾了关于 PLHIV 中 TPT 的最新出版物和指南。
高质量的研究表明，TPT 具有持久的效果，可预防 TB 和全因死亡率超过 5 年。有新的证据表明，基于利福平的 TPT 较短疗程具有非劣效性，增加了治疗选择。最近描述在不同环境中实施情况的研究表明，可行性、耐受性、保留率和成本效益方面有了有希望的结果。新的世卫组织建议对之前的版本进行了统一，以指导各国的实施。
新的证据支持在全球范围内扩大 PLHIV 的 TPT 应用，还需要进一步的研究为特定人群（如孕妇）以及与抗逆转录病毒药物的药物相互作用提供更多的证据。
