Kassim S, Sassan-Morokro M, Ackah A, Abouya L Y, Digbeu H, Yesso G, Coulibaly I M, Coulibaly D, Whitaker P J, Doorly R
Centres Antituberculeux, Abidjan, Côte d'Ivoire.
AIDS. 1995 Oct;9(10):1185-91. doi: 10.1097/00002030-199510000-00011.
To assess the response to therapy for tuberculosis using rifampicin-containing short-course chemotherapy, and to compare recurrence and mortality rates in seronegative persons and those with HIV-1, HIV-2, and dual serologic reactivity in West Africa.
A cohort of 835 adult patients (167 HIV-1-positive, 143 HIV-2-positive, 243 dual-reactive, 282 HIV-negative) with smear-positive pulmonary tuberculosis was followed for 2 years under programme conditions. Standard self-administered treatment was daily rifampicin and isoniazid for 6 months, and in addition pyrazinamide during the first 2 months. Outcomes evaluated were rates of completion of therapy, cure, failure of treatment, recurrence after cure, and mortality.
HIV-positive patients had lower rates of completion of therapy (65-73%) than seronegative patients (79%), mainly because of increased mortality. Among patients completing therapy, failure of treatment was similarly low in HIV-positive (2%) and seronegative patients (1%). Recurrence rates after cure did not differ significantly in the 18 months of follow-up in the four serologic groups (3-7%). The respective mortality rates for HIV-1-positive, HIV-2-positive, and dually reactive patients were 20.3, 8.3, and 25.5 per 100 person-years (PY), compared with 2.2 per 100 PY among seronegatives.
Rifampicin-containing short-course chemotherapy for pulmonary tuberculosis is associated with similar cure and recurrence rates in HIV-positive and HIV-negative persons completing 6 months of therapy. HIV-2 infection is associated with more favourable survival than HIV-1 infection or dual reactivity, even when AIDS-defining illness is already present. However, mortality is significantly increased in all seropositive groups compared with HIV-negative tuberculosis patients; thus, establishing the causes of this increased mortality is a priority.
评估含利福平的短程化疗对结核病的治疗反应，并比较西非血清学阴性者以及感染HIV-1、HIV-2和具有双重血清学反应性者的复发率和死亡率。
对835例涂片阳性的成年肺结核患者（167例HIV-1阳性、143例HIV-2阳性、243例双重反应性、282例HIV阴性）在项目条件下进行了2年的随访。标准的自我给药治疗方案为每日服用利福平和异烟肼6个月，在前2个月还需加用吡嗪酰胺。评估的结果包括治疗完成率、治愈率、治疗失败率、治愈后的复发率和死亡率。
HIV阳性患者的治疗完成率（65%-73%）低于血清学阴性患者（79%），主要原因是死亡率增加。在完成治疗的患者中，HIV阳性患者（2%）和血清学阴性患者（1%）的治疗失败率同样较低。在四个血清学组的18个月随访中，治愈后的复发率无显著差异（3%-7%）。HIV-1阳性、HIV-2阳性和双重反应性患者的死亡率分别为每100人年20.3、8.3和25.5例，而血清学阴性者为每100人年2.2例。
对于完成6个月治疗的HIV阳性和HIV阴性患者，含利福平的短程肺结核化疗的治愈率和复发率相似。即使已出现艾滋病界定疾病，HIV-2感染的生存情况也比HIV-1感染或双重反应性更为有利。然而，与HIV阴性的肺结核患者相比，所有血清学阳性组的死亡率均显著增加；因此，确定死亡率增加的原因是当务之急。
