HIV与结核病共感染：基于CD4⁺ T细胞分层的临床管理研究进展

HIV and Tuberculosis Co-Infection: Research Progress on Clinical Management Based on CD4⁺ T Cell Stratification

摘要: 艾滋病(AIDS)是由人类免疫缺陷病毒(HIV)引起的慢性传染病，其患者因CD4⁺ T淋巴细胞数量与功能受损而处于免疫抑制状态，显著增加结核分枝杆菌(MTB)感染的风险。本文系统综述了HIV/TB共感染的流行病学特征、免疫机制、临床表现、诊断策略及治疗管理，重点探讨了CD4⁺ T细胞水平在共感染过程中的核心作用。研究表明，CD4⁺ T细胞计数越低，结核病的易感性、肺外播散风险、临床表现不典型性及死亡率越高，尤其在CD4⁺ < 200 cells/μL人群中更为显著。诊断方面，CD4水平影响分子检测、免疫学检测及影像学表现的有效性，需根据免疫状态制定个体化诊断策略。治疗上，早期启动抗逆转录病毒治疗(ART)与延长抗结核疗程可显著改善预后，但需警惕免疫重建炎症综合征(IRIS)及药物相互作用等挑战。对未来降低HIV-MTB共感染患者病死率及改善其临床预后提供了理论基础。

Abstract: AIDS is a chronic infectious disease caused by the human immunodeficiency virus (HIV). Its patients are in a state of immunosuppression due to an impaired number and function of CD4⁺ T lymphocytes, which significantly increases the risk of Mycobacterium tuberculosis (MTB) infection. This article systematically reviews the epidemiological characteristics, immune mechanism, clinical manifestations, diagnostic strategies and treatment management of HIV/TB co-infection, and focuses on the core role of CD4⁺ T cell level in the process of co-infection. Studies show that the lower the CD4⁺ T cell count, the higher the susceptibility to tuberculosis, the risk of pulmonary spread, the atypical clinical manifestations and the mortality rate, especially in the CD4⁺ < 200 cells/μL population. In terms of diagnosis, the level of CD4 affects the effectiveness of molecular detection, immunological detection and imaging performance, and individualized diagnostic strategies need to be formulated according to the immune status. In terms of treatment, early initiation of antiretroviral therapy (ART) and prolonging the course of anti-tuberculosis treatment can significantly improve the prognosis, but it is necessary to be alert to challenges such as immunoreconstruction inflammatory syndrome (IRIS) and drug interactions. It provides a theoretical basis for reducing the mortality rate of HIV-MTB co-infected patients and improving their clinical prognosis in the future.