Center of Prevention and Control of AIDS, Almaty, Kazakhstan.
Tuberculosis Research and Prevention Center NGO, Yerevan, Armenia.
J Infect Dev Ctries. 2020 Nov 16;14(11.1):128S-132S. doi: 10.3855/jidc.11924.
Antiretroviral therapy (ART) is an effective preventive strategy against tuberculosis (TB) in people living with HIV (PLWH). In Kazakhstan, according to the revised HIV treatment guideline (2017), ART should be initiated immediately after HIV diagnosis established, regardless of CD4+ count.
To evaluate the impact of early initiation of ART on TB infection in PLWH registered in the Center of Prevention and Control of AIDS, Almaty, Kazakhstan, between 2008 and 2018.
A retrospective cohort study was conducted using the data of 4,053 patients from electronic HIV case management system (2008-2018) (EHCMS).
The study revealed low rates (12.6%) of rapid ART (≤ 1 month after HIV diagnosis). Patients in the rapid ART initiation group were less likely to develop TB compared with those who started treatment >1 month after the HIV detection (odds ratio 1.6; 95% confidence interval [1.1, 2.2]; p = 0.00799). Interestingly, the risk for developing TB among patients receiving ART ≥ 1 month after HIV diagnosis was significantly higher compared with those not taking any treatment. The latter was explained by several confounding not addressed during the analysis, since ART was prescribed to patients with primarily deeper immunodeficiency, while the patients not receiving ART were less immunocompromised.
Despite the recently changed HIV treatment guideline in Kazakhstan, ART is still initiated based on the disease severity. In 2018, the initiation of ART during the first month after HIV diagnosis increased by 50%. However, it is necessary to reduce the time to initiation of ART for all patients.
抗逆转录病毒疗法（ART）是预防人类免疫缺陷病毒（HIV）感染者发生结核病（TB）的有效策略。在哈萨克斯坦，根据修订后的 HIV 治疗指南（2017 年），无论 CD4+计数如何，HIV 诊断确立后应立即开始 ART。
评估哈萨克斯坦阿拉木图艾滋病预防和控制中心登记的 HIV 感染者（PLWH）中早期开始 ART 对 TB 感染的影响，时间范围为 2008 年至 2018 年。
采用电子 HIV 病例管理系统（EHCMS）中 4053 名患者的数据进行回顾性队列研究（2008-2018 年）。
研究显示，快速 ART（HIV 诊断后≤1 个月）的比例较低（12.6%）。与 HIV 检测后>1 个月开始治疗的患者相比，快速 ART 起始组发生 TB 的可能性较低（比值比 1.6；95%置信区间[1.1, 2.2]；p=0.00799）。有趣的是，与未接受任何治疗的患者相比，HIV 诊断后≥1 个月接受 ART 的患者发生 TB 的风险显著更高。这是由于在分析过程中未考虑到一些混杂因素，因为 ART 是为免疫功能严重受损的患者开具的，而未接受 ART 的患者免疫功能受损程度较低。
尽管哈萨克斯坦最近改变了 HIV 治疗指南，但仍根据疾病严重程度开始 ART。2018 年，HIV 诊断后第一个月内开始 ART 的比例增加了 50%。然而，仍有必要减少所有患者开始 ART 的时间。
