Paradoxical worsening of tuberculosis in HIV-infected persons
Paradoxical worsening of tuberculosis in HIV-infected persons
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DOI：
10.1378/chest.120.1.193
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发表时间：
2001-07-01
期刊：
影响因子：
9.6
通讯作者：
Sterling, TR
中科院分区：
文献类型：
--
作者：
Wendel, KA;Alwood, KS;Sterling, TR
目的：了解艾滋病病毒感染者结核（TB）矛盾加重的发生率。设计：观察性队列研究。环境：城市公共结核病诊所。患者：1996年1月1日至1999年12月31日期间接受结核病治疗的艾滋病毒感染者，随访至2000年6月30日。干预：患者接受标准的抗结核病治疗。抗逆转录病毒治疗由初级医疗提供者提供。接受抗逆转录病毒治疗的患者单独给予核苷类逆转录酶抑制剂或高活性抗逆转录病毒治疗（HAART；核苷类逆转录酶抑制剂与蛋白酶抑制剂或非核苷类逆转录酶抑制剂联合）。主要结局指标：结核病的矛盾恶化。结果：76例患者中结核82例。82例患者中有6例（7%；95%可信区间为3 - 15%）出现了矛盾性恶化，28例接受HAART治疗的患者中有3例（11%）出现矛盾性恶化，44例未接受抗逆转录病毒治疗的患者中有3例（7%）出现矛盾性恶化（p = 0.67）。与没有矛盾恶化的病例相比，合并矛盾恶化的病例在初始诊断时更有可能同时患有肺和肺外疾病（83% vs 24%; p 0.006）。在矛盾恶化的患者中，6例中有2例（33%）出现结核病复发，76例中有4例（5%）没有矛盾恶化（p = 0.06）。结论：与以前的报道相比，结核病的矛盾恶化发生率较低，且与HAART治疗无关。矛盾的恶化似乎也与结核病复发的风险增加有关。有必要进一步研究，以更好地描述矛盾恶化的危险因素，并在发生这种情况的患者中进行适当的抗结核治疗。
Objective: To determine the incidence of paradoxical worsening of tuberculosis (TB) in HIV-infected persons.Design: Observational cohort study.Setting: Public, urban TB clinic.Patients: HIV-infected persons treated for TB between January 1, 1996, and December 31, 1999, and followed through June 30, 2000,Intervention: Patients received standard anti-TB therapy. Antiretroviral therapy was provided by primary medical providers. Patients receiving antiretroviral therapy were given nucleoside reverse transcriptase inhibitors alone or highly active antiretroviral therapy (HAART; nucleoside reverse transcriptase inhibitors in combination with a protease inhibitor or a nonnucleoside reverse transcriptase inhibitor).Main outcome measure: Paradoxical worsening of TB.Results: There were 82 TB cases in 76 patients. Paradoxical worsening was identified in 6 of 82 cases (7%; 95% confidence interval, 3 to 15%), Paradoxical worsening occurred in 3 of 28 cases (11%) in patients receiving HAART and in 3 of 44 cases (7%) in patients not receiving antiretroviral therapy (p = 0.67). Cases complicated by paradoxical worsening were more likely to have both pulmonary and extrapulmonary disease at initial diagnosis than cases without paradoxical worsening (83% vs 24%; p 0.006). TB relapse occurred in 2 of 6 cases (33%) in patients with paradoxical worsening and in 4 of 76 cases (5%) in patients without paradoxical worsening (p = 0.06).Conclusions: Paradoxical worsening of TB occurred less frequently than in previous reports and was not associated with HAART. Paradoxical worsening also appeared to be associated with an increased risk of TB relapse. Further studies are warranted to better characterize the risk factors for paradoxical worsening and the appropriate duration of anti-TB therapy in patients in whom it occurs.