美国宾夕法尼亚大学Gregory P Bisson团队分析了抗逆转录病毒治疗和结核病药物治疗成人HIV和多药耐药结核病的疗效。2020年8月8日，该成果发表在《柳叶刀》杂志上。

HIV感染与多药耐药结核病治疗期间的死亡率增加有关，但尚不清楚抗逆转录病毒疗法（ART）和抗结核药的使用在多大程度上能降低这种风险。

为了评估上述治疗方法如何改变多药耐药性结核病的HIV阳性成年人的死亡风险，研究组对1993-2016年间确诊或疑似的多药耐药结核病并接受治疗的18岁以上成年人进行了单独的患者数据荟萃分析。这些数据包括根据世界卫生组织（WHO）有效性类别分组的抗病毒治疗和抗结核药物。

研究组纳入了11920名多药耐药结核病患者，其中2997例（25％）HIV阳性且接受ART治疗，886例（7％）HIV阳性但未接受ART治疗，1749例（15％）为广泛耐药结核病患者。以HIV阴性患者作为对照，所有HIV感染患者的死亡校正优势比（aOR）为2.4，HIV阳性且接受ART治疗的患者为1.8，HIV阳性且没有或未知是否接受ART治疗的患者为4.2。在HIV患者中，至少使用一种WHO的A类药物以及特定使用莫西沙星、左氧氟沙星、贝达喹啉或利奈唑胺的患者其死亡风险显著降低。

总之，使用ART药物和更有效的抗结核药物，可显著降低HIV阳性的多药耐药结核病患者的死亡率。

附：英文原文

Title: Mortality in adults with multidrug-resistant tuberculosis and HIV by antiretroviral therapy and tuberculosis drug use: an individual patient data meta-analysis

Author: Gregory P Bisson, Mayara Bastos, Jonathon R Campbell, Didi Bang, James C Brust, Petros Isaakadis, Christoph Lange, Dick Menzies, Giovanni B Migliori, Jean W Pape, Domingo Palmero, Parvaneh Baghei, Payam Tabarsi, Piret Viiklepp, Stalz Vilbrun, Jonathan Walsh, Suzanne M Marks

Issue&Volume: 2020/08/08

Abstract:

Background

HIV-infection is associated with increased mortality during multidrug-resistant tuberculosis treatment, but the extent to which the use of antiretroviral therapy (ART) and anti-tuberculosis medications modify this risk are unclear. Our objective was to evaluate how use of these treatments altered mortality risk in HIV-positive adults with multidrug-resistant tuberculosis.

Methods

We did an individual patient data meta-analysis of adults 18 years or older with confirmed or presumed multidrug-resistant tuberculosis initiating tuberculosis treatment between 1993 and 2016. Data included ART use and anti-tuberculosis medications grouped according to WHO effectiveness categories. The primary analysis compared HIV-positive with HIV-negative patients in terms of death during multidrug-resistant tuberculosis treatment, excluding those lost to follow up, and was stratified by ART use. Analyses used logistic regression after exact matching on country World Bank income classification and drug resistance and propensity-score matching on age, sex, geographic site, year of multidrug-resistant tuberculosis treatment initiation, previous tuberculosis treatment, directly observed therapy, and acid-fast-bacilli smear-positivity to obtain adjusted odds ratios (aORs) and 95% CIs. Secondary analyses were conducted among those with HIV-infection.

Findings

We included 11920 multidrug-resistant tuberculosis patients. 2997 (25%) were HIV-positive and on ART, 886 (7%) were HIV-positive and not on ART, and 1749 (15%) had extensively drug-resistant tuberculosis. By use of HIV-negative patients as reference, the aOR of death was 2·4 (95% CI 2·0–2·9) for all patients with HIV-infection, 1·8 (1·5–2·2) for HIV-positive patients on ART, and 4·2 (3·0–5·9) for HIV-positive patients with no or unknown ART. Among patients with HIV, use of at least one WHO Group A drug and specific use of moxifloxacin, levofloxacin, bedaquiline, or linezolid were associated with significantly decreased odds of death.

Interpretation

Use of ART and more effective anti-tuberculosis drugs is associated with lower odds of death among HIV-positive patients with multidrug-resistant tuberculosis. Access to these therapies should be urgently pursued.

DOI: 10.1016/S0140-6736(20)31316-7

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31316-7/fulltext