Adverse events and treatment interruption in tuberculosis patients with and without HIV coinfection
Adverse events and treatment interruption in tuberculosis patients with and without HIV coinfection
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DOI：
10.1136/thx.2006.058867
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发表时间：
2006-09-01
期刊：
影响因子：
10
通讯作者：
Lipman, M. C.
中科院分区：
文献类型：
--
作者：
Breen, R. A. M.;Miller, R. F.;Lipman, M. C.
背景资料：严重的治疗相关不良事件被认为在合并感染HIV的结核病（TB）患者中更常见。进行了一项研究，以评估严重（III/IV级）不良事件和抗结核治疗的中断在有效的抗逆转录病毒疗法的时代。方法：严重不良事件的发生率进行了回顾性比较，在312个人治疗结核病，其中156人合并感染艾滋病毒。111名艾滋病毒感染者（71%）在接受抗结核治疗的同时接受了高效抗逆转录病毒治疗。40%的HIV感染者和26%的HIV未感染者记录了严重不良事件（p=0.008）。周围神经病变和持续呕吐在合并感染患者中更常见（p < 0.001; p = 0.006），尽管两组中抗TB治疗的全因中断发生率相似（HIV感染患者为13%，HIV未感染患者为15%; p = 0.74）。在85%的HIV感染者和87%的HIV未感染者中，这是由于肝毒性，通常在开始治疗后2个月内出现。中位延迟重新开始治疗是4周，所以大多数人需要充分结核re-treatment.Conclusion：尽管更大的严重（III/IV级）不良事件的发生率在HIV感染者，抗结核治疗的中断发生在HIV感染者和HIV未感染者的频率相似。
Background: Serious treatment associated adverse events are thought to occur more frequently in individuals with tuberculosis ( TB) who are co-infected with HIV. A study was undertaken to assess the frequency of serious (grade III/IV) adverse events and interruption of anti-TB treatment in the era of effective antiretroviral therapy.Methods: The incidence of serious adverse events was retrospectively compared in 312 individuals treated for TB, 156 of whom were co-infected with HIV.Results: 111 HIV infected individuals (71%) received highly active antiretroviral therapy at the same time as anti-TB treatment. Serious adverse events were recorded in 40% HIV infected and 26% HIV uninfected individuals (p=0.008). Peripheral neuropathy and persistent vomiting were more common in co-infected patients (p < 0.001; p = 0.006), although all cause interruption of anti-TB treatment occurred with similar frequency in the two groups (13% in HIV infected patients and 15% in HIV uninfected patients; p = 0.74). In 85% of HIV infected patients and 87% of HIV uninfected individuals this was due to hepatotoxicity, which typically presented within 2 months of starting treatment. The median delay in restarting treatment was 4 weeks, so most individuals required full TB re-treatment.Conclusion: Despite a greater rate of serious (grade III/IV) adverse events among HIV infected individuals, discontinuation of anti-TB treatment occurred with a similar frequency in HIV infected and HIV uninfected individuals.