Centre for the AIDS Programme of Research in South Africa, Nelson R Mandela School of Medicine, College of Health Sciences, Medical Research Council-Centre for the AIDS Program of Research in South Africa HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Congella, South Africa.
Columbia University College of Physicians and Surgeons, New York, NY, USA.
Int J Tuberc Lung Dis. 2020 Oct 1;24(10):1024-1031. doi: 10.5588/ijtld.20.0048.
Bedaquiline (BDQ) has not been extensively studied among patients co-infected with HIV drug-resistant tuberculosis (DR-TB). We compared treatment outcomes in DR-TB patients treated with BDQ- and linezolid (LZD) containing regimens to historic controls treated with second-line injectable-containing regimens. Retrospective cohort study of consecutive DR-TB patients initiated on BDQ- and LZD-containing regimens at a TB referral hospital in KwaZulu-Natal, South Africa. Participants were prospectively followed through 24 months for treatment outcome and adverse events. Outcomes were compared to a historic control cohort of DR-TB HIV patients enrolled at the same facility prior to BDQ introduction. Adult DR-TB patients initiating BDQ between January 2014 and November 2015 were enrolled ( = 151). The majority of patients were female (52%), HIV co-infected (77%) and on antiretroviral therapy (100%). End of treatment outcomes included cure (63%), TB culture conversion (83%), completion (0.7%), loss to follow-up (15%), treatment failure (5%), and death (17%). Compared to historic controls ( = 105), patients treated with BDQ experienced significantly higher TB culture conversion and cure, with significantly lower mortality. Adverse effects were common (92%), and most frequently attributed to LZD (24.1%). QT segment prolongation was common but without clinical sequelae. Treatment with BDQ- and LZD-containing regimens was associated with improved treatment outcomes and survival in DR-TB HIV patients.
贝达喹啉（BDQ）在合并 HIV 耐药结核病（DR-TB）的患者中尚未得到广泛研究。我们比较了在结核病转诊医院接受 BDQ 和利奈唑胺（LZD）含药方案治疗的 DR-TB 患者与接受二线注射剂含药方案治疗的历史对照患者的治疗结局。这是一项在南非夸祖鲁-纳塔尔省的一家结核病转诊医院中进行的连续 DR-TB 患者的回顾性队列研究，这些患者开始接受 BDQ 和 LZD 含药方案治疗。参与者前瞻性随访 24 个月，以评估治疗结局和不良事件。将结局与在 BDQ 引入之前在同一机构登记的 DR-TB HIV 患者的历史对照队列进行比较。2014 年 1 月至 2015 年 11 月期间，开始接受 BDQ 治疗的成年 DR-TB 患者入组（n=151）。大多数患者为女性（52%），HIV 合并感染（77%）和接受抗逆转录病毒治疗（100%）。治疗结束时的结局包括治愈（63%）、结核培养转阴（83%）、完成治疗（0.7%）、失访（15%）、治疗失败（5%）和死亡（17%）。与历史对照（n=105）相比，接受 BDQ 治疗的患者结核培养转阴和治愈比例显著更高，死亡率显著更低。不良事件常见（92%），最常归因于 LZD（24.1%）。QT 段延长常见，但无临床后果。BDQ 和 LZD 含药方案治疗与 DR-TB HIV 患者的治疗结局改善和生存提高相关。
