New management approaches to tuberculosis in people living with HIV.
New management approaches to tuberculosis in people living with HIV.
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DOI：
10.1097/qco.0000000000000704
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发表时间：
2021-02-01
影响因子：
3.9
通讯作者：
中科院分区：
文献类型：
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作者：
艾滋病毒感染者（PLWH）通常同时感染结核分枝杆菌，特别是在高传播资源有限的地区。尽管抗逆转录病毒疗法和结核病治疗的普及率有所提高，但结核病仍然是艾滋病毒携带者死亡的主要原因。本综述讨论了艾滋病病毒感染者结核病管理的最新进展，并探讨了改善艾滋病病毒相关结核病结局的新兴治疗方法。最近的三项关键进展改变了艾滋病毒相关结核病的管理。首先，扩大了用于艾滋病毒感染者结核病筛查和诊断的护理点尿液快速检测，促进了早期病例发现和治疗。其次，增加治疗耐药结核病的有效新药和再利用药物的供应，使人们对耐多药结核病和广泛耐药结核病的治疗和结果感到乐观。第三，在资源有限的地区扩大整合酶抑制剂度鲁特韦治疗艾滋病毒的可及性，简化了结核病/艾滋病毒合并感染患者的管理，并最大限度地减少了严重不良事件。虽然在艾滋病毒相关结核病的早期发现和治疗方面取得了重大进展，但仍然存在重大的治疗挑战。为了优化艾滋病毒感染者结核病的管理和结局，应探索针对病原体并增强宿主反应的治疗方法。
People living with HIV (PLWH) are commonly co-infected with Mycobacterium tuberculosis, particularly in high-transmission resource-limited regions. Despite expanded access to antiretroviral therapy and tuberculosis (TB) treatment, TB remains the leading cause of death among PLWH. This review discusses recent advances in the management of TB in PLWH and examines emerging therapeutic approaches to improve outcomes of HIV-associated TB. Three recent key developments have transformed the management of HIV-associated TB. First, the scaling-up of rapid point-of-care urine-based tests for screening and diagnosis of TB in HIV-infected patients has facilitated early case detection and treatment. Second, increasing the availability of potent new and repurposed drugs to treat drug-resistant TB has generated optimism about the treatment and outcome of multidrug-resistant and extensively drug-resistant TB. Third, expanded access to the integrase inhibitor dolutegravir to treat HIV in resource-limited regions has simplified the management of TB/HIV co-infected patients and minimised serious adverse events. While it is unequivocal that substantial progress has been made in early detection and treatment of HIV-associated TB, significant therapeutic challenges persist. To optimise the management and outcomes of TB in HIV, therapeutic approaches that target the pathogen as well as enhance the host response should be explored.