Treatment outcomes in patients with drug-resistant TB-HIV co-infection treated with bedaquiline and linezolid.
Treatment outcomes in patients with drug-resistant TB-HIV co-infection treated with bedaquiline and linezolid.
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DOI：
10.5588/ijtld.20.0048
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发表时间：
2020-10-01
期刊：
影响因子：
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通讯作者：
O Donnell M
中科院分区：
文献类型：
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作者：
Padayatchi N;Bionghi N;Osman F;Naidu N;Ndjeka N;Master I;Brust JCM;Naidoo K;Ramjee A;O Donnell M
贝达喹啉尚未在 HIV 耐药结核病 (DR-TB) 合并感染患者中进行广泛研究。我们将接受含贝达喹啉和利奈唑胺方案治疗的耐药结核病患者的治疗结果与接受二线注射剂方案治疗的历史对照患者的治疗结果进行了比较。在南非夸祖鲁-纳塔尔省的一家结核病转诊医院，对连续耐药结核病患者开始接受含贝达喹啉和利奈唑胺治疗方案的回顾性队列研究。对参与者进行了为期 24 个月的前瞻性随访，了解治疗结果和不良事件。将结果与在引入贝达喹啉之前在同一机构登记的耐药结核病艾滋病毒患者的历史对照队列进行比较。纳入 2014 年 1 月至 2015 年 11 月期间开始使用贝达喹啉的成年耐药结核病患者 (N=151)。大多数患者是女性（52%）、同时感染艾滋病毒（77%）和接受抗逆转录病毒治疗（100%）。治疗结束结果包括治愈（63%）、结核菌培养转化（83%）、完成（0.7%）、失访（15%）、治疗失败（5%）和死亡（17%）。与历史对照（N=105）相比，接受贝达喹啉治疗的患者的结核培养转化率和治愈率显着提高，死亡率显着降低。不良反应很常见（92%），最常见的是利奈唑胺（24.1%）。 QT 段延长很常见，但没有临床后遗症。含贝达喹啉和利奈唑胺的治疗方案与耐药结核病艾滋病毒患者的治疗结果和生存率改善相关。
Bedaquiline has not been extensively studied among HIV drug-resistant tuberculosis (DR-TB) co-infected patients. We compared treatment outcomes in DR-TB patients treated with bedaquiline- and linezolid-containing regimens to historic controls treated with second-line injectable-containing regimens. Retrospective cohort study of consecutive DR-TB patients initiated on bedaquiline- and linezolid-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 bedaquiline introduction. Adult DR-TB patients initiating bedaquiline between January 2014 and November 2015 were enrolled (N=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 (N=105), patients treated with bedaquiline experienced significantly higher TB culture conversion and cure, with significantly lower mortality. Adverse effects were common (92%) and most frequently attributed to linezolid (24.1%). QT segment prolongation was common but without clinical sequelae. Treatment with bedaquiline- and linezolid-containing regimens was associated with improved treatment outcomes and survival in DR-TB HIV patients.