UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate®

HIV感染者潜伏结核感染的治疗

Author
Dick Menzies, MD, MSc
Section Editor
C Fordham von Reyn, MD
Deputy Editor
Elinor L Baron, MD, DTMH
Translators
贺建清, 主任医师，教授

引言

人类免疫缺陷病毒(human immunodeficiency virus, HIV)感染对结核(tuberculosis, TB)的流行病学、临床表现和结局有显著影响[1,2]。这两种流行病的交汇已导致了TB病例大幅猛增，特别是在资源有限的地区[3-5]。世界卫生组织(World Health Organization, WHO)估计，全球获得性免疫缺陷综合征(acquired immune deficiency syndrome, AIDS)患者中死亡病例的13%与TB相关[6]。HIV对TB病的影响在撒哈拉以南非洲地区尤为显著，1990-2005年间该地区TB发病率从约150例/100,000人增至超过400例/100,000人[4,5,7,8]。

本文将总结对HIV感染者通过潜伏结核感染(latent tuberculosis infection, LTBI)治疗来预防活动性TB病的相关问题。HIV感染者中LTBI的诊断和活动性TB病的治疗将单独讨论。 (参见“HIV感染患者中潜伏结核感染的诊断”和“HIV成人感染者的肺结核治疗”)

一般概念

TB感染是由吸入活的结核杆菌所致；这些微生物通常以非活动状态持续存在(称为LTBI)；某些情况下吸入结核杆菌后，可迅速进展为活动性TB病。LTBI个体没有症状且没有传染性。潜伏的TB杆菌仍是活的，并可能在数年后再激活，引起活动性有症状的且具有传染性的TB病[9]。

TB的自然病程将单独进一步讨论。 (参见“结核病的自然病程、微生物学及发病机制”)

发生进展的危险因素 — 进展为活动性TB病的危险因素包括[10-13]：

                  

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: 2017-06 . | This topic last updated: 2017-07-13.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
References
Top
  1. Narain JP, Raviglione MC, Kochi A. HIV-associated tuberculosis in developing countries: epidemiology and strategies for prevention. Tuber Lung Dis 1992; 73:311.
  2. Pitchenik AE, Burr J, Suarez M, et al. Human T-cell lymphotropic virus-III (HTLV-III) seropositivity and related disease among 71 consecutive patients in whom tuberculosis was diagnosed. A prospective study. Am Rev Respir Dis 1987; 135:875.
  3. World Health Organization. Global Tuberculosis Report 2009. http://www.who.int/tb/publications/global_report/2009/en/index.html (Accessed on August 25, 2011).
  4. World Health Organization. Global Tuberculosis Control. Surveillance, Planning, Financing: 2010. World Health Organization, Geneva 2011 (WHO/HTM/TB/2010.362).
  5. Harries AD, Zachariah R, Corbett EL, et al. The HIV-associated tuberculosis epidemic--when will we act? Lancet 2010; 375:1906.
  6. World Health Organization. Guidelines for Intensified tuberculosis case finding and isoniazid preventive therapy for people living with HIV in resource constrained settings, Geneva, 2011.
  7. Panel on Opportunistic Infections in HIV-Infected Adults and Adolescents. Guidelines for the prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: Recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. http://aidsinfo.nih.gov/contentfiles/lvguidelines/adult_oi.pdf (Accessed on September 21, 2016).
  8. World Health Organization. Global Tuberculosis Control: Surveillance, Planning, Financing. WHO, Geneva 2005.
  9. CDC. Guidelines for the investigation of contacts of persons with infectious tuberculosis: recommendations from the National Tuberculosis Controllers Association and CDC. MMWR 2005;54(No. RR-15).
  10. Elzi L, Schlegel M, Weber R, et al. Reducing tuberculosis incidence by tuberculin skin testing, preventive treatment, and antiretroviral therapy in an area of low tuberculosis transmission. Clin Infect Dis 2007; 44:94.
  11. Samandari T, Agizew TB, Nyirenda S, et al. 6-month versus 36-month isoniazid preventive treatment for tuberculosis in adults with HIV infection in Botswana: a randomised, double-blind, placebo-controlled trial. Lancet 2011; 377:1588.
  12. Mwinga A, Hosp M, Godfrey-Faussett P, et al. Twice weekly tuberculosis preventive therapy in HIV infection in Zambia. AIDS 1998; 12:2447.
  13. Sterling TR, Lau B, Zhang J, et al. Risk factors for tuberculosis after highly active antiretroviral therapy initiation in the United States and Canada: implications for tuberculosis screening. J Infect Dis 2011; 204:893.
  14. Shwander SK, Ellner J. The human host: Immunology and susceptibility. In: Tuberculosis, 20th ed, Raviglione MC. (Ed), Informa Healthcare, New York 2006. p.117.
  15. Menzies D, Fanning A, Yuan L, Fitzgerald M. Tuberculosis among health care workers. N Engl J Med 1995; 332:92.
  16. Daley CL, Small PM, Schecter GF, et al. An outbreak of tuberculosis with accelerated progression among persons infected with the human immunodeficiency virus. An analysis using restriction-fragment-length polymorphisms. N Engl J Med 1992; 326:231.
  17. Page KR, Godfrey-Fausset P, Chaisson RE. Tuberculosis-HIV coinfection: epidemiology, clinical aspects, and interventions. In: Reichman and Hershfield's Tuberculosis: A Comprehensive International Approach, Raviglione MC. (Ed), Informa Healthcare, New York 2006. p.371.
  18. Selwyn PA, Hartel D, Lewis VA, et al. A prospective study of the risk of tuberculosis among intravenous drug users with human immunodeficiency virus infection. N Engl J Med 1989; 320:545.
  19. Wood R, Maartens G, Lombard CJ. Risk factors for developing tuberculosis in HIV-1-infected adults from communities with a low or very high incidence of tuberculosis. J Acquir Immune Defic Syndr 2000; 23:75.
  20. Comstock GW, Edwards LB, Livesay VT. Tuberculosis morbidity in the U.S. Navy: its distribution and decline. Am Rev Respir Dis 1974; 110:572.
  21. Golub JE, Pronyk P, Mohapi L, et al. Isoniazid preventive therapy, HAART and tuberculosis risk in HIV-infected adults in South Africa: a prospective cohort. AIDS 2009; 23:631.
  22. Martinson NA, Barnes GL, Moulton LH, et al. New regimens to prevent tuberculosis in adults with HIV infection. N Engl J Med 2011; 365:11.
  23. Jordan TJ, Lewit EM, Montgomery RL, Reichman LB. Isoniazid as preventive therapy in HIV-infected intravenous drug abusers. A decision analysis. JAMA 1991; 265:2987.
  24. Sterling TR, Bethel J, Goldberg S, et al. The scope and impact of treatment of latent tuberculosis infection in the United States and Canada. Am J Respir Crit Care Med 2006; 173:927.
  25. Akolo C, Adetifa I, Shepperd S, Volmink J. Treatment of latent tuberculosis infection in HIV infected persons. Cochrane Database Syst Rev 2010; :CD000171.
  26. Whalen CC, Johnson JL, Okwera A, et al. A trial of three regimens to prevent tuberculosis in Ugandan adults infected with the human immunodeficiency virus. Uganda-Case Western Reserve University Research Collaboration. N Engl J Med 1997; 337:801.
  27. Cohen T, Lipsitch M, Walensky RP, Murray M. Beneficial and perverse effects of isoniazid preventive therapy for latent tuberculosis infection in HIV-tuberculosis coinfected populations. Proc Natl Acad Sci U S A 2006; 103:7042.
  28. Foster S, Godfrey-Faussett P, Porter J. Modelling the economic benefits of tuberculosis preventive therapy for people with HIV: the example of Zambia. AIDS 1997; 11:919.
  29. Targeted tuberculin testing and treatment of latent tuberculosis infection. This official statement of the American Thoracic Society was adopted by the ATS Board of Directors, July 1999. This is a Joint Statement of the American Thoracic Society (ATS) and the Centers for Disease Control and Prevention (CDC). This statement was endorsed by the Council of the Infectious Diseases Society of America. (IDSA), September 1999, and the sections of this statement. Am J Respir Crit Care Med 2000; 161:S221.
  30. Tuberculosis Prevention and Control, Public Health Agency of Canada, the Canadian Lung Association. Canadian Lung Association, 6th ed, Long RL, Ellis E. (Eds), Public Health Agency of Canada, Toronto 2007.
  31. World Health Organization. WHO Three I's Meeting, World Health Organization, Geneva, 2009. p.161.
  32. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5302a6.htm (Accessed on August 29, 2011).
  33. TEMPRANO ANRS 12136 Study Group, Danel C, Moh R, et al. A Trial of Early Antiretrovirals and Isoniazid Preventive Therapy in Africa. N Engl J Med 2015; 373:808.
  34. Golub JE, Cohn S, Saraceni V, et al. Long-term protection from isoniazid preventive therapy for tuberculosis in HIV-infected patients in a medium-burden tuberculosis setting: the TB/HIV in Rio (THRio) study. Clin Infect Dis 2015; 60:639.
  35. Rangaka MX, Wilkinson RJ, Boulle A, et al. Isoniazid plus antiretroviral therapy to prevent tuberculosis: a randomised double-blind, placebo-controlled trial. Lancet 2014; 384:682.
  36. Mtei L, Matee M, Herfort O, et al. High rates of clinical and subclinical tuberculosis among HIV-infected ambulatory subjects in Tanzania. Clin Infect Dis 2005; 40:1500.
  37. Day JH, Charalambous S, Fielding KL, et al. Screening for tuberculosis prior to isoniazid preventive therapy among HIV-infected gold miners in South Africa. Int J Tuberc Lung Dis 2006; 10:523.
  38. Getahun H, Matteelli A, Abubakar I, et al. Management of latent Mycobacterium tuberculosis infection: WHO guidelines for low tuberculosis burden countries. Eur Respir J 2015; 46:1563.
  39. Saukkonen JJ, Cohn DL, Jasmer RM, et al. An official ATS statement: hepatotoxicity of antituberculosis therapy. Am J Respir Crit Care Med 2006; 174:935.
  40. Smieja MJ, Marchetti CA, Cook DJ, Smaill FM. Isoniazid for preventing tuberculosis in non-HIV infected persons. Cochrane Database Syst Rev 2000; :CD001363.
  41. Efficacy of various durations of isoniazid preventive therapy for tuberculosis: five years of follow-up in the IUAT trial. International Union Against Tuberculosis Committee on Prophylaxis. Bull World Health Organ 1982; 60:555.
  42. Snider DE Jr, Caras GJ, Koplan JP. Preventive therapy with isoniazid. Cost-effectiveness of different durations of therapy. JAMA 1986; 255:1579.
  43. Comstock GW. How much isoniazid is needed for prevention of tuberculosis among immunocompetent adults? Int J Tuberc Lung Dis 1999; 3:847.
  44. Ferebee SH. Controlled chemoprophylaxis trials in tuberculosis. A general review. Bibl Tuberc 1970; 26:28.
  45. AIDS Info: Clinical Guidelines Portal. http://aidsinfo.nih.gov/guidelines (Accessed on May 14, 2015).
  46. Sterling TR, Villarino ME, Borisov AS, et al. Three months of rifapentine and isoniazid for latent tuberculosis infection. N Engl J Med 2011; 365:2155.
  47. Centers for Disease Control and Prevention (CDC). Recommendations for use of an isoniazid-rifapentine regimen with direct observation to treat latent Mycobacterium tuberculosis infection. MMWR Morb Mortal Wkly Rep 2011; 60:1650.
  48. Centers for Disease Control and Prevention. Managing drug interactions in the treatment of HIV-related tuberculosis. 2013. http://www.cdc.gov/tb/publications/guidelines/TB_HIV_Drugs/default.htm (Accessed on April 20, 2015).
  49. Centers for Disease Control and Prevention (CDC), American Thoracic Society. Update: adverse event data and revised American Thoracic Society/CDC recommendations against the use of rifampin and pyrazinamide for treatment of latent tuberculosis infection--United States, 2003. MMWR Morb Mortal Wkly Rep 2003; 52:735.
  50. World Health Organization. Recommendation on 36 months isoniazid preventive therapy to adults and adolescents living with HIV in resource-constrained and high TB- and HIV-prevalence settings, 2015 update. WHO, Geneva 2015. http://apps.who.int/iris/bitstream/10665/174052/1/9789241508872_eng.pdf?ua=1&ua=1 (Accessed on July 14, 2015).
  51. Churchyard GJ, Fielding KL, Lewis JJ, et al. A trial of mass isoniazid preventive therapy for tuberculosis control. N Engl J Med 2014; 370:301.
  52. Kopanoff DE, Snider DE Jr, Caras GJ. Isoniazid-related hepatitis: a U.S. Public Health Service cooperative surveillance study. Am Rev Respir Dis 1978; 117:991.
  53. Gordin F, Chaisson RE, Matts JP, et al. Rifampin and pyrazinamide vs isoniazid for prevention of tuberculosis in HIV-infected persons: an international randomized trial. Terry Beirn Community Programs for Clinical Research on AIDS, the Adult AIDS Clinical Trials Group, the Pan American Health Organization, and the Centers for Disease Control and Prevention Study Group. JAMA 2000; 283:1445.
  54. Gao XF, Wang L, Liu GJ, et al. Rifampicin plus pyrazinamide versus isoniazid for treating latent tuberculosis infection: a meta-analysis. Int J Tuberc Lung Dis 2006; 10:1080.
  55. Soriano V, Puoti M, Garcia-Gascó P, et al. Antiretroviral drugs and liver injury. AIDS 2008; 22:1.
  56. A double-blind placebo-controlled clinical trial of three antituberculosis chemoprophylaxis regimens in patients with silicosis in Hong Kong. Hong Kong Chest Service/Tuberculosis Research Centre, Madras/British Medical Research Council. Am Rev Respir Dis 1992; 145:36.
  57. Villarino ME, Ridzon R, Weismuller PC, et al. Rifampin preventive therapy for tuberculosis infection: experience with 157 adolescents. Am J Respir Crit Care Med 1997; 155:1735.
  58. Menzies D, Long R, Trajman A, et al. Adverse events with 4 months of rifampin therapy or 9 months of isoniazid therapy for latent tuberculosis infection: a randomized trial. Ann Intern Med 2008; 149:689.
  59. Steele MA, Burk RF, DesPrez RM. Toxic hepatitis with isoniazid and rifampin. A meta-analysis. Chest 1991; 99:465.
  60. Burger DM, Agarwala S, Child M, et al. Effect of rifampin on steady-state pharmacokinetics of atazanavir with ritonavir in healthy volunteers. Antimicrob Agents Chemother 2006; 50:3336.
  61. Severe P, Pape J, Fitzgerald D. A randomized clinical trial of early versus standard antiretroviral therapy for HIV-infected patients with a CD4 T-cell count of 200-350 cells/mL (CIPRAHT001). Paper presented at the 49th Interscience Conference on Antimicrobial Agents and Chemotherapy; Sept 12-15, 2009; San Francisco, CA. Abstract:H1230c.
  62. Lawn SD, Myer L, Edwards D, et al. Short-term and long-term risk of tuberculosis associated with CD4 cell recovery during antiretroviral therapy in South Africa. AIDS 2009; 23:1717.
  63. Cohen MS, Chen YQ, McCauley M, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med 2011; 365:493.
  64. Severe P, Juste MA, Ambroise A, et al. Early versus standard antiretroviral therapy for HIV-infected adults in Haiti. N Engl J Med 2010; 363:257.