Singh Abhijeet, Prasad Rajendra, Balasubramanian Viswesvaran, Gupta Nikhil
Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, New Delhi, Delhi 110007, India.
Department of Pulmonary Medicine, King George Medical University, Lucknow, Uttar Pradesh 226003, India.
HIV AIDS (Auckl). 2020 Jan 13;12:9-31. doi: 10.2147/HIV.S193059. eCollection 2020.
Drug-resistant tuberculosis (DR-TB), including multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB), is considered a potential obstacle for elimination of TB globally. HIV coinfection with M/XDR-TB further complicates the scenario, and is a potential threat with challenging management. Reports have shown poor outcomes and alarmingly high mortality rates among people living with HIV (PLHIV) coinfected with M/XDR-TB. This coinfection is also responsible for all forms of M/XDR-TB epidemics or outbreaks. Better outcomes with reductions in mortality have been reported with concomitant treatment containing antiretroviral drugs for the HIV component and antitubercular drugs for the DR-TB component. Early and rapid diagnosis with genotypic tests, prompt treatment with appropriate regimens based on drug-susceptibility testing, preference for shorter regimens fortified with newer drugs, a patient-centric approach, and strong infection-control measures are all essential components in the management of M/XDR-TB in people living with HIV.
耐多药结核病（DR-TB），包括多重耐药结核病（MDR-TB）和广泛耐药结核病（XDR-TB），被认为是全球消除结核病的潜在障碍。HIV与M/XDR-TB合并感染使情况更加复杂，并且是管理方面具有挑战性的潜在威胁。报告显示，合并感染M/XDR-TB的艾滋病毒感染者（PLHIV）预后不佳，死亡率高得惊人。这种合并感染也是所有形式的M/XDR-TB流行或暴发的原因。据报告，同时使用针对HIV成分的抗逆转录病毒药物和针对DR-TB成分的抗结核药物进行治疗，可取得更好的效果并降低死亡率。采用基因检测进行早期快速诊断、根据药敏试验使用适当方案进行及时治疗、优先选用含新药强化的短程方案、以患者为中心的方法以及强有力的感染控制措施，都是艾滋病毒感染者M/XDR-TB管理的重要组成部分。
