HIV 与一线结核病治疗中利福霉素耐药性获得的关联：系统评价和荟萃分析。

Association between HIV and acquisition of rifamycin resistance with first-line TB treatment: a systematic review and meta-analysis.

机构信息

Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.

Division of Public Health Medicine, School of Public Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.

出版信息

BMC Infect Dis. 2024 Jul 1;24(1):657. doi: 10.1186/s12879-024-09514-7.

DOI:10.1186/s12879-024-09514-7

PMID:38956461

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11218187/

Abstract

BACKGROUND

Multi-drug or rifamycin-resistant tuberculosis (MDR/RR-TB) is an important public health concern, including in settings with high HIV prevalence. TB drug resistance can be directly transmitted or arise through resistance acquisition during first-line TB treatment. Limited evidence suggests that people living with HIV (PLHIV) might have an increased risk of acquired rifamycin-resistance (ARR).

METHODS

To assess HIV as a risk factor for ARR during first-line TB treatment, a systematic review and meta-analysis was conducted. ARR was defined as rifamycin-susceptibility at treatment start with rifamycin-resistance diagnosed during or at the end of treatment, or at recurrence. PubMed/MEDLINE, CINAHL, Cochrane Library, and Google Scholar databases were searched from inception to 23 May 2024 for articles in English; conference abstracts were also searched from 2004 to 2021. The Mantel-Haenszel random-effects model was used to estimate the pooled odds ratio of any association between HIV and ARR among individuals receiving first-line TB treatment.

RESULTS

Ten studies that included data collected between 1990 and 2014 were identified: five from the United States, two from South Africa and one each from Uganda, India and Moldova. A total of 97,564 individuals were included across all studies, with 13,359 (13.7%) PLHIV. Overall, 312 (0.32%) acquired rifamycin-resistance, among whom 115 (36.9%) were PLHIV. The weighted odds of ARR were 4.57 (95% CI, 2.01-10.42) times higher among PLHIV compared to HIV-negative individuals receiving first-line TB treatment.

CONCLUSION

The available data, suggest that PLHIV have an increased ARR risk during first-line TB treatment. Further research is needed to clarify specific risk factors, including advanced HIV disease and TB disease severity. Given the introduction of shorter, 4-month rifamycin-based regimens, there is an urgent need for additional data on ARR, particularly for PLHIV.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42022327337.

摘要

背景

耐多药或利福平耐药结核病（MDR/RR-TB）是一个重要的公共卫生关注点，包括在 HIV 流行率较高的环境中。结核病药物耐药性可通过直接传播或在一线结核病治疗期间通过耐药性获得而发生。有限的证据表明，艾滋病毒感染者（PLHIV）可能有更高的获得利福平耐药性（ARR）的风险。

方法

为了评估 HIV 作为一线结核病治疗期间 ARR 的危险因素，进行了系统评价和荟萃分析。ARR 定义为治疗开始时对利福霉素敏感，而在治疗期间或结束时或复发时诊断出利福平耐药性，或在治疗开始时对利福霉素敏感，而在治疗期间或结束时或复发时诊断出利福平耐药性。从 1990 年至 2024 年 5 月 23 日，在 PubMed/MEDLINE、CINAHL、Cochrane 图书馆和 Google Scholar 数据库中以英文搜索文章；还从 2004 年至 2021 年搜索会议摘要。使用 Mantel-Haenszel 随机效应模型估计在接受一线结核病治疗的个体中，HIV 与 ARR 之间任何关联的合并优势比。

结果

共确定了 10 项研究，这些研究的数据收集时间在 1990 年至 2014 年之间：5 项来自美国，2 项来自南非，1 项分别来自乌干达、印度和摩尔多瓦。所有研究共纳入 97564 人，其中 13359 人（13.7%）为 PLHIV。总体而言，有 312 人（0.32%）获得利福平耐药性，其中 115 人（36.9%）为 PLHIV。与接受一线结核病治疗的 HIV 阴性个体相比，PLHIV 发生 ARR 的加权优势比为 4.57（95%CI，2.01-10.42）倍。