MALABSORPTION OF ANTITUBERCULOUS DRUGS IN BOTSWANA

描述 据估计，全球结核病疫情将导致90 本十年新增病例100万例，发病率最高发生在#年 撒哈拉以南非洲地区的艾滋病毒感染率也很高。这 艾滋病毒和结核病流行之间日益密切的联系引起了人们的担忧 关于传统抗结核治疗对艾滋病毒/结核病的疗效 病人。获得性结核病相关死亡率更高 据报道，携带艾滋病毒的结核病患者出现了耐药性和复发。一个 这些不良后果的潜在解释是生物利用度低。 HIV患者口服药物的使用情况。初步证据显示口服液 HIV感染者对抗结核药物的吸收不可靠 患者，超过30%的艾滋病毒感染者可能吸收不良 他们的毒品。 该提案概述了一项对540名结核病患者进行的为期3年的前瞻性队列研究。 住进博茨瓦纳哈博罗内的玛丽娜公主医院。基线， 临床、微生物学和实验室数据，包括艾滋病毒血清和 异烟肼(H)、利福平(R)、乙胺丁醇(E)和吡嗪酰胺(P)的血清 将获得浓度。患者将接受为期18个月的跟踪调查 治疗结束后评估疗效。横断面调查 在前100名入选的患者中，将进行 药物吸收不良的流行率，并确定危险因素和可能的 吸收不良的机制。在治疗过程中死于结核病的患者， 获得抗药性，或在治疗后复发将被确定和 将确定发病率。死于结核病或复发的患者将 作为病例在不同嵌套病例对照研究中确定 吸收不良的治疗意义。

DESCRIPTION Estimates suggest the global tuberculosis [TB] epidemic will result in 90 million new cases this decade, with the highest incidence rates occurring in sub-Saharan Africa where the prevalence of HIV infection is also high. This growing interface between the HIV and TB epidemics has raised concerns regarding the efficacy of conventional antituberculosis therapy in HIV/TB patients. Higher rates of TB-associated mortality, acquired drug-resistance, and relapse have been reported in TB patients with HIV. A potential explanation for these adverse outcomes is the low bioavailability of oral medications in HIV patients. Preliminary evidence suggests the oral absorption of anti-tuberculosis drugs is unreliable in HIV-infected patients, and that more than 30 % of all HIV-infected patients may malabsorb their drugs. This proposal outlines a 3 year prospective cohort study of 540 TB patients admitted to the Princess Marina Hospital in Gaborone, Botswana. Baseline, clinical, microbiologic, and laboratory data, including HIV serologies and serum for isoniazid (H), rifampin (R), ethambutol (E), and pyrazinamide (P) concentrations will be obtained. Patients will be followed for 18 months after the completion of therapy to assess outcome. A cross-sectional survey of the first 100 patients enrolled will be performed to measure the prevalence of drug malabsorption, and to identify risk factors and possible mechanisms for malabsorption. Patients who die of TB while on therapy, acquire drug-resistance, or relapse following therapy will be identified and incidence rates will be determined. Patients who die of TB or relapse will serve as case patients in different nested case-control studies to determine the therapeutic significance of malabsorption.