Tuberculosis in HIV-infected persons in the context of wide availability of highly active antiretroviral therapy
Tuberculosis in HIV-infected persons in the context of wide availability of highly active antiretroviral therapy
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DOI：
10.1183/09031936.04.00109303
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发表时间：
2004-07-01
影响因子：
24.3
通讯作者：
Ippolito, G
中科院分区：
文献类型：
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作者：
Girardi, E;Antonucci, G;Ippolito, G
高效抗逆转录病毒疗法（HAART）大大降低了艾滋病毒感染者患结核病的风险。尽管如此，在广泛使用高效抗逆转录病毒疗法的国家，艾滋病毒相关结核病仍在发生。为了确定在高效抗逆转录病毒疗法的情况下患结核病的艾滋病毒感染者的特征，目前的作者分析了1999年至2000年期间在意大利诊断的271名患者的数据。这些患者占在参与本研究的临床单位接受治疗的40，413名HIV感染患者的0.7%，从数据中观察到20名患者（7.4%）既往有结核病发作，但未完成治疗。81名患者（29.9%）在结核病诊断时被诊断为艾滋病毒感染者，108名（39.8%）知道自己的艾滋病毒感染状况，但没有接受抗逆转录病毒治疗，82名（30.3%）正在接受抗逆转录病毒治疗。接受抗逆转录病毒治疗的患者的免疫抑制显著低于同时诊断为结核病的HIV患者或其他未接受抗逆转录病毒治疗的患者（中位CD 4淋巴细胞计数：220个细胞（.）mm（-3）与100个细胞（.）mm（-3）和109个细胞（.）mm（-3））。根据抗逆转录病毒治疗的状态，结核病的临床表现没有显着差异记录。失败的结核病控制干预措施（如未完成治疗）和艾滋病毒护理（艾滋病毒感染的诊断延误和治疗的次优吸收）可能会导致艾滋病毒相关的结核病在一个国家，在那里高度活跃的抗逆转录病毒治疗是很大程度上可持续的发生。然而，很大一部分病例发生在正在接受抗逆转录病毒治疗的患者中。
Highly active antiretroviral therapy (HAART) greatly reduces the risk of developing tuberculosis for HIV-infected persons. Nonetheless, HIV-associated tuberculosis continues to occur in countries where HAART is widely used.To identify the characteristics of HIV-infected persons who develop tuberculosis in the context of the availability of HAART, the current authors analysed data taken from 271 patients diagnosed, in Italy, during 1999-2000. These patients represent 0.7% of the 40,413 HIV-infected patients cared for in the clinical units participating in this current study.From the data it was observed that 20 patients (7.4%) had a previous episode of tuberculosis whose treatment was not completed. Eighty-one patients (29.9%) were diagnosed with HIV at tuberculosis diagnosis, 108 (39.8%) were aware of their HIV status but were not on antiretroviral treatment and 82 (30.3%) were on antiretroviral treatment. Patients on antiretroviral treatment were significantly less immunosuppressed than patients with HIV diagnosed concurrently with tuberculosis, or other patients not on antiretrovirals (median CD4 lymphocytes count: 220 cells(.)mm(-3) versus 100 cells(.)mm(-3) and 109 cells(.)mm(-3) respectively). No significant differences in clinical presentation of tuberculosis according to antiretroviral therapy status were recorded.Failure of tuberculosis control interventions (e.g. noncompletion of treatment) and of HIV care (delayed diagnosis of HIV infection and suboptimal uptake of therapy) may contribute to continuing occurrence of HIV-associated tuberculosis in a country where highly active antiretroviral therapy is largely available. However, a significant proportion of cases occur in patients who are on antiretroviral treatment.