TB/HIV双重感染者治疗中的问题与建议

doi:10.3969/j.issn.2096-8493.2020.01.004

摘要/Abstract

摘要：

目前,艾滋病并发结核病已成为严重威胁我国公众健康的重要公共卫生问题,TB/HIV双重感染者死亡率较HIV阴性结核病患者高,治疗过程中涉及到抗结核和抗HIV治疗2个方面。其抗病毒治疗的启动时间、药品相互作用、药品耐受性和结核病相关免疫重建综合征的预防与治疗等问题,使抗结核和抗HIV治疗面临严重挑战。作者就目前关于TB/HIV双重感染患者治疗与管理中最新的研究,结合文献和临床经验进行论述。

关键词: 结核, HIV感染, 重叠感染, 治疗过程片断, 基于问题的学习

Abstract:

AIDS complicated with tuberculosis (TB) has become a serious public health problem in China. The mortality rate of TB/HIV co-infection is higher than that of HIV-negative TB patients. The treatment process involves anti-TB and anti-HIV treatment. Anti-TB and anti-HIV treatment are faced with serious challenges due to the initiation time of antiviral therapy, drug interactions, drug tolerance, the prevention and treatment of TB-associated immune reconstitution syndrome. The author discusses the latest research on the treatment and management of patients with TB/HIV co-infection, combined with literature and clinical experience.

Key words: Tuberculosis, HIV infections, Superinfection, Episode of care, Problem-based learning

吴桂辉, 黄涛. TB/HIV双重感染者治疗中的问题与建议[J]. 结核与肺部疾病杂志, 2020, 1(1): 11-16. doi: 10.3969/j.issn.2096-8493.2020.01.004

WU Gui-hui, HUANG Tao. Problems and suggestions in the treatment of TB/HIV coinfection[J]. Journal of Tuberculosis and Lung Disease, 2020, 1(1): 11-16. doi: 10.3969/j.issn.2096-8493.2020.01.004

图/表 1

参考文献 28

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抗病毒药品	异烟肼	乙胺丁醇	吡嗪酰胺	利福布汀	利福平	备注
阿巴卡韦 (abacavir)	+	+	+	+	±	利福平增加了葡萄糖醛酸化作用,阿巴卡韦暴露量轻微减少,剂量无需调整
依非韦伦 (efavirenz)	+	+	+	±	±	利福平剂量不变,利福布汀450~600mg/次,1次/d
埃替拉韦/考比司他 (elvitegravir/c)	+	+	+	±	?	考比司他与利福平为禁忌;与利福布汀联用减量至150mg/次,隔日1次
拉米夫定 (lamivudine)	+	+	+	+	+
洛匹那韦/利托那韦 (lopinavir/r)	+	+	+	±	?	与利福平配伍禁忌;利福布汀剂量调整为150mg/次,1次/d
奈韦拉平 (nevirapine)	+	+	+	±	?	与利福布汀合用剂量不变
拉替拉韦 (raltegravir)	+	+	+	+	±	与利福平联用时,拉替拉韦剂量调整为800mg/次,2次/d
利匹韦林 (rilpivirine)	+	+	+	±	?	与利福布汀避免联合使用,如非必要,则利匹韦林调整剂量为50mg/次,1次/d,同时警惕Q-T间期延长风险
替诺福韦 (tenofovir)	+	+	+	+	+
齐多夫定 (zidovudine)	+	+	+	+	±	利福平增加齐多夫定的清除率,减少47%的血浆暴露量
马拉维罗 (maraviroc)	+	+	+	±	±	利福平降低马拉韦罗克暴露60%~70%,与利福平合用时剂量调整为600mg/次,2次/d;与利福布汀合用时剂量不调整