Effect of Simultaneous Use of Highly Active Antiretroviral Therapy on Survival of HIV Patients With Tuberculosis
Effect of Simultaneous Use of Highly Active Antiretroviral Therapy on Survival of HIV Patients With Tuberculosis
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DOI：
10.1097/qai.0b013e31819367e7
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发表时间：
2009-02-01
影响因子：
3.6
通讯作者：
Guijarro, Carlos
中科院分区：
文献类型：
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作者：
Velasco, Maria;Castilla, Virgilio;Guijarro, Carlos
导言：艾滋病和结核病患者开始高活性抗逆转录病毒治疗（HAART）的最佳时机是一个未解决的问题。为了评估HAART对结核病患者生存的影响，我们设计了这项研究。方法：我们选择1996年以后诊断为结核的COMESEM队列中所有HIV患者。登记临床和流行病学资料。我们比较了在诊断为结核病时开始HAART治疗的患者[同时治疗（ST）]和未开始HAART治疗的患者。采用Cox分析评估生存率。结果：纳入队列的6934例HIV患者中，1217例合并结核，其中322例（26.5%）为1996年以后。在结核诊断时，其中45%开始HAART （ST）治疗。除了ST患者的病毒载量较低外，各组之间的基础特征没有差异。ST治疗与生存率提高相关（风险比0.38；95%可信区间0.20 ~ 0.72,P = 0.003）。通过单变量分析，生存率也与静脉内不使用药物和结核病诊断年份较晚有关。在校正了其他预后变量后，通过Cox多因素分析，ST仍然与生存率的提高有显著相关性（风险比0.37；95%可信区间0.17 ~ 0.66,P = 0.001）。结论：艾滋病合并结核病患者同时接受HAART和TB治疗可提高生存率。
Introduction: The optimal timing for initiation of highly active antiretroviral therapy (HAART) in patients with AIDS and tuberculosis (TB) is an unresolved question. To assess the effect of HAART on the survival of patients with TB, we designed this study.Methods: We selected all HIV patients included in the COMESEM cohort with TB diagnosis after 1996. Clinical and epidemiological data were registered. We compared patients who started HAART at the diagnosis of TB [simultaneous therapy (ST)] or not. Survival was assessed by Cox analysis.Results: Among the 6934 HIV patients included in the cohort, 1217 patients had TB, 322 of them (26.5%) after 1996. At the time of TB diagnosis, 45% of them started HAART (ST). There were no differences between groups regarding basal characteristics, except for a lower viral load in ST patients. ST therapy was associated with improved survival (hazard ratio 0.38; 95% confidence interval 0.20 to 0.72, P = 0.003). By univariate analysis, survival was also associated with no endovenous drug use and a later year of TB diagnosis. After adjusting for other prognostic variables, by Cox multivariate analysis, ST remained robustly associated with improved survival (hazard ratio 0.37; 95% confidence interval 0.17 to 0.66, P = 0.001).Conclusions: Simultaneous HAART and TB treatment in HIV patients with TB is associated with improved survival.