摘要
地点:马拉维农村Thyolo区医院。目的:报告临床、免疫学和病毒学结果和艾滋病合并结核病患者同时接受奈韦拉平(NVP)和利福平(RMP)治疗的安全性。设计:回顾性队列研究。方法:分析2007年6—12月的规划数据。结果:在156例接受基于NVP抗病毒治疗的艾滋病合并结核病患者中,136例(87%)成功地完成了结核病治疗,16例(10%)死亡,5例(4%)迁出。平均体质量和CD4细胞计数增量(成人)分别为4.4 kg(95%可信区间为3.3～5.4)和140个/mm^3(95%可信区间为117～162)。在完成抗结核治疗且获得病毒载量检测结果的患者中(n=74),74%的患者病毒载量处于未检出水平(<50个拷贝/ml),17例(22%)患者的病毒载量为50～1 000个拷贝/ml。在基线时,2例(1.3%)患者出现肝中毒。在抗结核治疗期间,2例患者和1例患者分别达到2级和3级谷丙转氨酶升高(每10年的随访发病率为4.2,95%可信区间为1.4～13.1)。没有与肝中毒相关的死亡报告。结论:在马拉维的农村地区,同时服用NVP和RMP可以获得很好的结核病治疗效果,并且安全。对患者进行进一步的随访,将有助于确定目前治疗的远期效果。
SETTING: Thyolo District Hospital, rural Malawi.
OBJECTIVES: To report on 1) clinical, immunological and virological outcomes and 2) safety among human immunodeficiency virus (HIV) infected patients with tuberculosis (TB) who received concurrent nevirapine (NVP) and rifampicin (RMP) based treatment.
DESIGN: Retrospective cohort study.
METHODS: Analysis of programme data, JuneCDecember 2007.
RESULTS: Of a total of 156 HIV-infected TB patients who started NVP-based antiretroviral treatment, 136 (87%) completed TB treatment successfully, 16 (10%) died and 5 (4%) were transferred out. Mean body weight and CD4 gain (adults) were respectively 4.4 kg (95%CI 3.3C5.4) and 140 cells/mm3 (95%CI 117C162). Seventy-four per cent of patients who completed TB treatment and had a viral load performed (n = 74) had undetectable levels (<50 copies/ml), while 17 (22%) had a viral load of 50C1000 copies/ml. Hepatotoxicity was present in 2 (1.3%) patients at baseline. Two patients developed Grade 2 and one developed Grade 3 alanine transaminase enzyme elevations during TB treatment (incidence rate per 10 years of follow-up 4.2, 95%CI 1.4C13.1). There were no reported deaths linked to hepatotoxicity.
CONCLUSIONS: In a rural district in Malawi, concomitant NVP and RMP treatment is associated with good TB treatment outcomes and appears safe. Further follow-up of patients would be useful to ascertain the longer-term effects of this concurrent treatment.
出处
《国际结核病与肺部疾病杂志》
2010年第2期197-202,共7页
The International Journal of Tuberculosis and Lung Disease
基金
The Thyolo district HIV/AIDS programme is supported by Medecins sans Frontieres. EuropeAid
la Direction Generale de la Cooperation au Developpement(Belgium Government)
the Childrens Investment Fund Foundation
ELMA Foundation
the Global Fund
the International Union Against Tuberculosis and Lung Disease
Paris
and the World Health Organization
for their continuing support for HIV/AIDS activities in Malawi
