Outcomes of HIV-infected versus HIV-non-infected patients treated for drug-resistance tuberculosis: Multicenter cohort study

Background
The emergence of resistance to anti-tuberculosis (DR-TB) drugs and the HIV epidemic represent a serious threat for reducing the global burden of TB. Although data on HIV-negative DR-TB treatment outcomes are well published, few data on DR-TB outcomes among HIV co-infected people is available despite the great public health importance.
Methods
We retrospectively reported and compared the DR-TB treatment outcomes of HIV-positive and HIV-negative patients treated with an individualized regimen based on WHO guidelines in seven countries: Abkhazia, Armenia, Colombia, Kenya, Kyrgyzstan, Swaziland and Uzbekistan.
Results
Of the 1,369 patients started DRTB treatment, 809 (59.1%) were multi-drug resistant (MDR-TB) and 418 (30.5%) were HIV-positive. HIV-positive patients were mainly from African countries (90.1%) while HIV-negative originated from Former Soviet Union (FSU) countries. Despite a higher case fatality rate (19.0% vs 9.4%), HIV-positive MDR-TB patients had a 10% higher success rate than HIV-negative patients (64.0% vs 53.2%, p = 0.007). No difference in treatment success was found among polydrug-resistant (PDR-TB) patients. Overall, lost to follow-up rate was much higher among HIV-negative (22.0% vs. 8.4%). Older age and not receiving ART were the only factors associated with unfavorable treatment outcome among HIV-positive patients.
Conclusions
As already known for HIV-negative patients, success rate of DR-TB HIV-positive patients remains low and requires more effective DR-TB regimen using new drugs also suitable to HIV-infected patients on ART. The study also confirms the need of ART introduction in HIV co-infected patients.

研究背景
抗结核药物耐药结核病（Drug-Resistant Tuberculosis, DR-TB）的出现以及人类免疫缺陷病毒（Human Immunodeficiency Virus, HIV）流行，对全球结核病负担的控制构成了严重威胁。尽管HIV阴性耐药结核病患者的治疗结局数据已得到充分发表，但尽管其公共卫生意义重大，目前关于HIV合并感染人群的耐药结核病治疗结局的数据仍十分匮乏。

研究方法
本研究回顾性报告并比较了7个国家（阿布哈兹、亚美尼亚、哥伦比亚、肯尼亚、吉尔吉斯斯坦、斯威士兰及乌兹别克斯坦）中，依据世界卫生组织（World Health Organization, WHO）指南采用个体化治疗方案治疗的HIV阳性与HIV阴性耐药结核病患者的治疗结局。

研究结果
在1369例启动耐药结核病治疗的患者中，809例（59.1%）为耐多药结核病（Multi-Drug Resistant Tuberculosis, MDR-TB），418例（30.5%）为HIV阳性。HIV阳性患者主要来自非洲国家（90.1%），而HIV阴性患者则多源自前苏联（Former Soviet Union, FSU）国家。尽管HIV阳性耐多药结核病患者的病死率更高（19.0% vs 9.4%），但其治疗成功率较HIV阴性患者高出10%（64.0% vs 53.2%，p=0.007）。在多药耐药结核病（Polydrug Resistant Tuberculosis, PDR-TB）患者中未观察到治疗成功率的差异。总体而言，HIV阴性患者的失访率显著更高（22.0% vs 8.4%）。年龄较大以及未接受抗反转录病毒治疗（Antiretroviral Therapy, ART）是HIV阳性患者出现不良治疗结局的唯一相关因素。

研究结论
正如已知的HIV阴性患者情况一样，HIV阳性耐药结核病患者的治疗成功率仍然偏低，亟需开发更有效的耐药结核病治疗方案，采用同样适用于接受抗反转录病毒治疗的HIV感染者的新型药物。本研究同时证实，需为HIV合并感染患者引入抗反转录病毒治疗。