Tuberculosis mortality, drug resistance, and infectiousness in patients with and without HIV infection in Peru
Tuberculosis mortality, drug resistance, and infectiousness in patients with and without HIV infection in Peru
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DOI：
10.4269/ajtmh.2006.75.1027
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发表时间：
2006-12-01
影响因子：
3.3
通讯作者：
Evans, Carlton A.
中科院分区：
文献类型：
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作者：
Kawai, Vivian;Soto, Giselle;Evans, Carlton A.
HIV合并感染和耐多药结核病（MDRTB）对结核病预后的影响尚不明确。因此，我们研究了秘鲁社区接受标准、直接观察、短期治疗的287例结核病患者的传染性和死亡率。在6-17个月的治疗期间，49名（18%）患者死亡，其中48名（98%）患有艾滋病，28名（57%）患有耐多药结核病；17/31（55%）的耐多药结核病艾滋病患者在诊断后2个月内死亡，而传统的药敏试验无法确定其耐多药结核病。大多数非耐多药结核病患者在治疗6周内变为涂片和培养阴性，而大多数耐多药结核病患者在死亡或治疗完成前仍保持痰培养阳性。hiv阴性的非耐多药结核病患者预后良好。然而。耐多药结核病与长期传染性和艾滋病毒合并感染与早期死亡有关，这表明需要更多地获得抗逆转录病毒治疗。此外，需要进行早期和快速的结核病药敏试验和感染控制，以便耐多药结核病能够及早得到适当治疗，以降低死亡率和传播。
The effects of HIV co-infection and multi-drug resistant tuberculosis (MDRTB) on tuberculosis prognosis are poorly defined. Therefore, we studied infectiousness and mortality of 287 tuberculosis patients treated with standard, directly observed, short-course therapy in the Peruvian community. During 6-17 months of treatment, 49 (18%) of patients died, of whom 48 (98%) had AIDS and 28 (57%) had MDRTB; 17/31 (55%) of MDRTB-patients with AIDS died within 2 months of diagnosis, before traditional susceptibility testing would have identified their MDRTB. Most non-MDRTB became smear- and culture-negative within 6 weeks of therapy, whereas most MDRTB remained sputum-culture-positive until death or treatment completion. HIV-negative patients with non-MDRTB had good outcomes. However. MDRTB was associated with prolonged infectiousness and HIV co-infection with early mortality, indicating a need for greater access to anti-retroviral therapy. Furthermore, early and rapid tuberculosis drug-susceptibility testing and infection control are required so that MDRTB can be appropriately treated early enough to reduce mortality and transmission.