Paradoxical worsening of tuberculosis following antiretroviral therapy in patients with AIDS
Paradoxical worsening of tuberculosis following antiretroviral therapy in patients with AIDS
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DOI：
10.1164/ajrccm.158.1.9712001
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发表时间：
1998-07-01
影响因子：
24.7
通讯作者：
Pitchenik, AE
中科院分区：
文献类型：
--
作者：
Narita, M;Ashkin, D;Pitchenik, AE
抗结核治疗后结核症状和病变的短暂恶化（矛盾反应）以前被描述为罕见的发生。为了确定艾滋病和结核病患者在接受抗结核药物治疗并随后接受抗逆转录病毒联合治疗（ARV）时的矛盾反应发生率，我们进行了一项前瞻性研究，33名接受抗结核治疗和抗逆转录病毒治疗的hiv -血清阳性结核病患者（第一组）与55名接受抗结核治疗的hiv -血清阴性结核病患者（第二组）和28名接受抗结核治疗但未接受抗逆转录病毒治疗的hiv -血清阳性结核病患者（历史对照；第三组）进行了比较。在第1组患者中，矛盾反应在时间上与开始抗逆转录病毒治疗的关系比与开始抗结核治疗的关系更大（平均+/- SD: 15 +/- 11天对109 +/- 72天[p < 0.001]），与第2组（1 / 55;2%）（p < 0.001）或第3组（2 / 28;7%）（p = 0.013）相比，发生的频率更高（12 / 33;36%）。在第1组中，大多数经历矛盾反应并接受结核菌素纯化蛋白衍生物（PPD）治疗的患者在抗逆转录病毒治疗后结核菌素皮肤试验从阴性转为强阳性。这些观察结果表明，在艾滋病毒感染的结核病患者开始抗逆转录病毒治疗后，可能会出现与结核菌素皮肤反应性增强相关的矛盾反应。此外，开始抗逆转录病毒药物治疗后的皮肤试验转换可能具有重要的公共卫生影响。
Transient worsening of tuberculous symptomatology and lesions following antituberculous therapy (paradoxical response) has previously been described as a rare occurrence. To determine the incidence of paradoxical responses in patients with AIDS and TB who are treated with antituberculous therapy and subsequently with combination antiretroviral therapy (ARV), we conducted a prospective study of 33 HIV-seropositive TB patients treated with anti-TB therapy and antiretroviral therapy (Group 1) compared with 55 HIV-seronegative TB patients treated with anti-TB therapy (Group 2) and 28 HIV-seropositive TB patients treated with anti-TB therapy but not on antiretrovirals (historical control; Group 3). In Group 1 patients, paradoxical responses were temporally more related to the initiation of ARV than to the initiation of anti-TB therapy (mean +/- SD: 15 +/- 11 d versus 109 +/- 72 d [p < 0.001]) and occurred much more frequently (12 of 33; 36%) compared with Group 2 (1 of 55; 2%) (p < 0.001) or with Group 3 (2 of 28; 7%) (p = 0.013). The majority of patients who experienced paradoxical responses and received tuberculin purified protein derivative (PPD) in Group 1 had their tuberculin skin tests convert from negative to strongly positive after ARV. These observations suggest that a paradoxical response associated with enhanced tuberculin skin reactivity may occur after the initiation of ARV in HIV-infected TB patients. Furthermore, the skin test conversion after the initiation of ARV may have important public health implications.