Management of tuberculosis and latent tuberculosis infection in human immunodeficiency virus-infected persons
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摘要The syndemic of human immunodeficiency virus (HIV)/tuberculosis (TB) co-infection has grown as a result of the considerable sociogeographic overlaps between the two epidemics. The situation is particularly worrisome in countries with high or intermediate TB burden against the background of a variable HIV epidemic state. Early diagnosis of TB disease in an HIV-infected person is paramount but suffers from lack of sensitive and specific diagnostic tools. Enhanced symptom screening is currently advocated, and the wide application of affordable molecular diagnostics is urgently needed. Treatment of TB/HIV co-infection involves the concurrent use of standard antiretrovirals and antimycobacterials during which harmful drug interaction may occur. The pharmacokinetic interaction between rifamycin and antiretrovirals is a case in point, requiring dosage adjustment and preferential use of rifabutin, if available. Early initiation of antiretroviral therapy is indicated, preferably at 2 weeks after starting TB treatment for patients with a CD4 of <50 cells/mu L. Development of TB-immune reconstitution inflammatory syndrome (TB-IRIS) is however more frequent with early antiretroviral therapy. The diagnosis of TB-IRIS is another clinical challenge, and cautious use of corticosteroids is suggested to improve clinical outcome. As a preventive measure against active TB disease, the screening for latent TB infection should be widely practiced, followed by at least 6-9 months of isoniazid treatment. To date tuberculin skin test remains the only diagnostic tool in high TB burden countries. The role of alternative tests, for example, interferon-gamma release assay, would need to be better defined for clinical application.
著者Lee SS, Meintjes G, Kamarulzaman A, Leung CC
期刊名稱Respirology
出版年份2013
月份8
日期1
卷號18
期次6
出版社WILEY-BLACKWELL
頁次912 - 922
國際標準期刊號1323-7799
電子國際標準期刊號1440-1843
語言英式英語
關鍵詞antiretroviral therapy; immune reconstitution inflammatory syndrome; latent tuberculosis; tuberculosis
Web of Science 學科類別Respiratory System; RESPIRATORY SYSTEM

上次更新時間 2020-13-10 於 01:57