Optimal Timing of Antiretroviral Therapy Initiation in Children and Adolescents With Human Immunodeficiency Virus-Associated Pulmonary Tuberculosis.
Optimal Timing of Antiretroviral Therapy Initiation in Children and Adolescents With Human Immunodeficiency Virus-Associated Pulmonary Tuberculosis.
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DOI：
10.1093/cid/ciac765
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发表时间：
2023-01-06
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在患有人类免疫缺陷病毒（CAHIV）的儿童和青少年中，没有足够的证据来指导在开始肺结核（pTB）治疗后开始抗逆转录病毒治疗（ART）的时间。为了解决这一知识缺口，我们评估了与ART初治CAHIV患者接受pTB治疗的ART开始时间相关的死亡风险。数据提取自2013年至2020年期间在博茨瓦纳、斯威士兰、马拉维、莱索托、坦桑尼亚或乌干达的贝勒卓越中心接受HIV相关pTB治疗的0-19岁ART初治患者的电子病历。采用未校正的Kaplan-Meier曲线和考克斯比例风险模型，针对全因死亡率的主要结局分析数据。研究人群包括774例CAHIV，在开始TB治疗后开始ART的间隔时间不同：<2周（n = 266），2周至2个月（n = 398），>2个月（n = 66），未开始ART（n = 44）。校正后的考克斯比例风险模型显示，从未开始抗逆转录病毒治疗的儿童与在结核治疗开始后2周至2个月内开始抗逆转录病毒治疗的儿童相比，结核治疗开始后1年的死亡率增加（校正后的HR [aHR]：2.67; 95% CI：1.03，6.94）。<2周组的死亡率风险（aHR：1.02; 95% CI：0.55，1.89）与2周至2个月之间开始ART的组没有差异。这项回顾性研究表明，在结核病治疗开始后<2周开始ART的CAHIV患者中，死亡率没有增加。鉴于抗逆转录病毒治疗的广泛健康益处，这一证据支持世卫组织最近对CAHIV的建议，即在开始结核病治疗后2周内开始抗逆转录病毒治疗。这项回顾性研究评估了根据结核病（TB）治疗开始后ART开始时间分类的ART初治儿童和青少年的死亡风险。我们的分析表明，在结核病治疗开始后2周内开始抗逆转录病毒治疗时，死亡率没有增加。
There is insufficient evidence in children and adolescents with human immunodeficiency virus (CAHIV) to guide the timing of antiretroviral treatment (ART) initiation after starting treatment for pulmonary tuberculosis (pTB). To address this knowledge gap, we evaluated the risk of mortality associated with timing of ART initiation in ART-naive CAHIV treated for pTB. Data were extracted from electronic medical records of ART-naive patients, aged 0–19 years, who were treated for HIV-associated pTB at Baylor Centers of Excellence in Botswana, Eswatini, Malawi, Lesotho, Tanzania, or Uganda between 2013 and 2020. Data were analyzed against a primary outcome of all-cause mortality with unadjusted Kaplan-Meier curves and Cox proportional hazard models. The study population included 774 CAHIV with variable intervals to ART initiation after starting TB treatment: <2 weeks (n = 266), 2 weeks to 2 months (n = 398), >2 months (n = 66), and no ART initiated (n = 44). Adjusted Cox proportional hazards models demonstrated increased mortality 1 year from TB treatment initiation in children never starting ART (adjusted HR [aHR]: 2.67; 95% CI: 1.03, 6.94) versus children initiating ART between 2 weeks and 2 months from TB treatment initiation. Mortality risk did not differ for the <2-weeks group (aHR: 1.02; 95% CI: .55, 1.89) versus the group initiating ART between 2 weeks and 2 months. This retrospective study demonstrated no increase in mortality among CAHIV initiating ART <2 weeks from TB treatment initiation. Given the broad health benefits of ART, this evidence supports the recent WHO recommendation for CAHIV to initiate ART within 2 weeks of initiating TB treatment. This retrospective study evaluates mortality risk in ART-naive children and adolescents categorized by the timing of ART initiation following tuberculosis (TB) treatment initiation. Our analysis demonstrates no increased mortality when starting ART within 2 weeks of TB treatment initiation.
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