Enimil Anthony K, Eley Brian, Nuttall James
Department of Paediatrics and Child Health, College of Health Sciences, University of Cape Town, Cape Town, South Africa.
Department of Paediatrics and Child Health, College of Health Sciences, Red Cross War Memorial Children's Hospital, Cape Town, South Africa.
South Afr J HIV Med. 2020 Aug 24;21(1):1121. doi: 10.4102/sajhivmed.v21i1.1121. eCollection 2020.
There is very limited published experience with intravenous (IV) antituberculosis (anti-TB) and antiretroviral therapy (ART) especially in children. We have described a human immunodeficiency virus (HIV)-infected child with complicated abdominal tuberculosis who was initially treated with IV anti-TB and a partially IV ART regimen before transitioning to oral therapy.
A 3-year-old boy presented with hypovolaemic shock with a 3-day history of inability to pass stools, abdominal distension and bile-stained vomiting. Abdominal ultrasound and X-ray showed small-bowel obstruction. Human immunodeficiency virus antibody testing was positive, and Cluster of Differentiation (CD)4+ lymphocyte count was 56 cells/mL (15%). Xpert (MTB)/Rifampicin (RIF) Ultra and TB culture on induced sputum detected MTB complex sensitive to rifampicin and isoniazid.
Following laparotomy and closure of bowel perforations, the child was commenced on IV rifampicin, moxifloxacin and amikacin. Amikacin was stopped after 3 days because of nephrotoxicity, and meropenem and IV linezolid were added. After 20 days, ART comprising IV zidovudine, oral lamivudine solution, oral lopinavir/ritonavir solution and additional oral ritonavir solution for super boosting was commenced. By day 40, the patient was well established on oral feeds and was switched to standard oral anti-TB medications. Sputum examined 1 month after starting the treatment was found culture-negative for MTB. After 4 months of treatment, the HIV viral load was < 100 copies/mL. He completed a total of 12 months of anti-TB treatment.
Despite limited experience and few available IV formulations of standard anti-TB and ARV medications, initial IV therapy may be beneficial for patients in whom oral medication is not an option.
关于静脉注射抗结核和抗逆转录病毒疗法（ART）的已发表经验非常有限，尤其是在儿童中。我们描述了一名感染人类免疫缺陷病毒（HIV）且患有复杂腹部结核的儿童，该儿童最初接受静脉注射抗结核治疗和部分静脉注射ART方案，之后过渡到口服治疗。
一名3岁男孩因低血容量性休克就诊，有3天未解大便、腹胀和胆汁样呕吐史。腹部超声和X线显示小肠梗阻。人类免疫缺陷病毒抗体检测呈阳性，分化簇（CD）4+淋巴细胞计数为56个细胞/毫升（15%）。诱导痰的Xpert（MTB）/利福平（RIF）Ultra检测和结核培养检测到对利福平和异烟肼敏感的结核分枝杆菌复合群。
剖腹手术并闭合肠穿孔后，该儿童开始接受静脉注射利福平、莫西沙星和阿米卡星治疗。由于肾毒性，3天后停用阿米卡星，并加用美罗培南和静脉注射利奈唑胺。20天后，开始ART治疗，包括静脉注射齐多夫定、口服拉米夫定溶液、口服洛匹那韦/利托那韦溶液以及额外的口服利托那韦溶液用于超增效。到第40天时，患者经口喂养情况良好，改为标准口服抗结核药物治疗。开始治疗1个月后检查的痰液结核培养结果为阴性。治疗4个月后，HIV病毒载量<100拷贝/毫升。他总共完成了12个月的抗结核治疗。
尽管标准抗结核和抗逆转录病毒药物的静脉注射制剂经验有限且可用剂型较少，但初始静脉注射治疗可能对无法选择口服药物的患者有益。
