The effect of tuberculosis treatment on virologic and immunologic response to combination antiretroviral therapy among South African children.
The effect of tuberculosis treatment on virologic and immunologic response to combination antiretroviral therapy among South African children.
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DOI：
10.1097/qai.0000000000000284
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发表时间：
2014-10-01
期刊：
影响因子：
--
通讯作者：
Rie AV
中科院分区：
文献类型：
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作者：
Soeters HM;Sawry S;Moultrie H;Rie AV
许多感染艾滋病毒的儿童被诊断为结核病(TB)，但结核病治疗对联合抗逆转录病毒疗法(CART)的病毒学和免疫应答的影响尚未有很好的文献报道。对启动CART的0-8岁感染CART的南非儿童的预期队列进行二次分析，以评估在CART开始时的结核病治疗对病毒学抑制(HIV RNA<；50拷贝/毫升)、病毒学反弹(HIV RNA>；抑制后1000拷贝/毫升)以及在CART的前24个月内CD4细胞百分比(CD4%)增加的影响。在199名儿童(中位年龄2.1岁)中，92名(46%)在CART开始时接受了结核病治疗。在CART开始时接受和未接受结核病治疗的儿童有相似的中位基线HIV RNA(5.4拷贝/毫升比5.6拷贝/毫升)、中位病毒抑制时间(每组6.2个月，AHR 1.36，95%可信区间0.94-1.96)和24个月的病毒反弹比率(23%对24%，AHR 1.53，95%可信区间0.71-3.30)。接受结核病治疗的儿童在基线(15.3%比18.8%，P<；0.01)和CART的前12个月中，CD4%的中位数显著降低，但在CART的6个月(9.9%比9.6%)、12个月(14.2%比11.9%)和24个月(14.5%比14.2%)中，CD4%的中位数上升相似。探索性分析表明，接受基于洛匹那韦/利托那韦的CART和结核病治疗的儿童的病毒学和免疫学反应可能比接受基于Eefavirenz的CART的儿童更差。在CART启动时接受结核病治疗对幼儿CART的病毒学或免疫学反应没有实质性影响。
Many HIV-infected children are diagnosed with tuberculosis (TB), but the effect of TB treatment on virologic and immunologic response to combination antiretroviral therapy (cART) is not well documented. Secondary analysis of a prospective cohort of cART-naïve HIV-infected South African children aged 0-8 years initiating cART to assess the effect of TB treatment at time of cART initiation on virologic suppression (HIV RNA <50 copies/mL), virologic rebound (HIV RNA >1000 copies/mL after suppression), and CD4 cell percentage (CD4%) increase during the first 24 months of cART. Of 199 children (median age 2.1 years), 92 (46%) were receiving TB treatment at cART initiation. Children receiving and not receiving TB treatment at cART initiation had similar median baseline HIV RNA (5.4 vs. 5.6 copies/mL), median time to virologic suppression (6.2 months in each group, aHR 1.36, 95% CI 0.94-1.96) and rates of virologic rebound by 24 months (23% vs. 24%, aHR 1.53, 95% CI 0.71-3.30). Children on TB treatment had significantly lower median CD4% at baseline (15.3% vs. 18.8%, P<0.01) and during the first 12 months of cART, but experienced similar median increases in CD4% at 6 months (9.9% vs. 9.6%), 12 months (14.2% vs. 11.9%) and 24 months of cART (14.5% vs. 14.2%). Exploratory analyses suggest that children receiving lopinavir/ritonavir-based cART and TB treatment may have inferior virologic and immunologic response compared to children receiving efavirenz-based cART. Receiving TB treatment at time of cART initiation did not substantially affect virologic or immunologic responses to cART in young children.