HIV感染/AIDS合并结核病的临床研究进展
Progress in Clinical Research of HIV Infection/AIDS Combined with Tuberculosis
摘要: 世界范围内人获得性免疫缺陷病毒(HIV)感染/获得性免疫缺陷综合征(AIDS)合并结核病(TB)的发病率和检出率不断升高,HIV可诱导机体炎性因子分泌和体细胞免疫功能缺陷的增加,从而增加患者感染结核分枝杆菌(Mycobacterium tuberculosis,MTB)的风险。而感染MTB可上调共受体CCR5和CXCR4的表达,从而促进HIV病毒感染巨噬细胞和T细胞。HIV感染/AIDS合并TB患者的结核症状于免疫功能有关,同时以Gene Xpert MTB/RIF为代表的新型分子生物学技术也具有良好的病原学诊断价值。目前,科学规范的临床治疗、管理仍是HIV感染/AIDS合并TB首选的防控策略。因此,本文对HIV感染/AIDS合并TB的流行病学、发病机制、临床表现及诊治等方面进行综述,以期为HIV感染/AIDS合并TB的临床防控提供一定的参考依据。
Abstract: The incidence and detection rate of human acquired immunodeficiency virus (HIV) infec-tion/acquired immunodeficiency syndrome (AIDS) combined with tuberculosis (TB) are increasing worldwide. HIV can induce the secretion of inflammatory factors and the increase of somatic im-mune dysfunction. That increases the risk of contracting Mycobacterium tuberculosis (MTB). How-ever, infection with MTB can up-regulate the expression of co-receptors CCR5 and CXCR4, thus pro-moting HIV infection of macrophages and T cells. The tuberculosis symptoms of HIV infection/AIDS patients with TB are related to immune function. Meanwhile, the novel molecular biological tech-nology represented by Gene Xpert MTB/RIF also has good value in etiological diagnosis. At present, scientific and standardized clinical treatment and management are still the preferred prevention and control strategies for HIV infection/AIDS complicated with TB. Therefore, this paper reviews the epidemiology, pathogenesis, clinical manifestations, diagnosis and treatment of HIV infec-tion/AIDS complicated with TB, in order to provide certain reference for the clinical prevention and control of HIV infection/AIDS complicated with TB.
文章引用:陈秋菊, 陈晓红. HIV感染/AIDS合并结核病的临床研究进展[J]. 临床医学进展, 2023, 13(2): 1493-1500. https://doi.org/10.12677/ACM.2023.132207

参考文献

[1] World Health Organization (2018) HIV/AIDS. http://www.who.int/mediacentre/factsheets/fs360/en/
[2] 揣征然, 张云辉, 赵雅琳, 等. 全球及中国AIDS最新疫情概况[J]. 传染病信息, 2020, 33(6): 501-503.
[3] 魏华英, 王立静, 崔晓, 等. 中国北方部分地区人类免疫缺陷病毒合并播散性鸟分枝杆菌复合群感染者的临床特征及预后影响因素[J]. 中国医药导报, 2022, 19(28): 102-105, 110.
[4] Maimaiti, R., Zhang, Y., Pan, K., et al. (2017) High Prevalence and Low Cure Rate of Tuberculosis among Patients with HIV in Xinjiang, China. BMC Infectious Diseases, 17, Article No. 15. [Google Scholar] [CrossRef] [PubMed]
[5] 中华医学会结核病学分会, 利奈唑胺抗结核治疗专家共识编写组. 利奈唑胺抗结核治疗专家共识[J]. 中华结核和呼吸杂志, 2018, 41(1): 14-19.
[6] 覃舒扬. 肺结核合并艾滋病患者接受抗结核治疗后病情的转归情况及影响因素分析[J]. 当代医药论丛, 2021, 19(12): 58-59.
[7] 李素容, 何涛. 结核分枝杆菌艾滋病病毒双重感染者死亡风险因素分析[J]. 中国病毒病杂志, 2018, 8(3): 200-203.
[8] 赵丁源, 叶建君, 侯双翼, 等. TB/HIV双重感染者抗结核疗效及其影响因素分析[J]. 中国艾滋病性病, 2020, 26(5): 534-536, 550.
[9] 方喆, 黄移生, 王起, 等. 2017-2019年长沙地区HIV感染者/AIDS患者合并肺结核感染的流行现状及相关危险因素[J]. 职业与健康, 2020, 36(13): 1784-1788.
[10] Mendelsohn, S.C., Fiore-Gartland, A., Penn-Nicholson, A., et al. (2021) Validation of a Host Blood Transcriptomic Biomarker for Pulmo-nary Tuberculosis in People Living with HIV: A Prospective Diagnostic and Prognostic Accuracy Study. The Lancet Global Health, 9, e841-e853. [Google Scholar] [CrossRef
[11] 邱振纲, 何晓, 黄才斌, 等. 多功能 Th1细胞在抗结核免疫保护机制中的作用研究进展[J]. 临床肺科杂志, 2012, 17(12): 2257-2259.
[12] 厉虹淼, 唐飞, 陈双双, 等. 艾滋病与结核病双重感染的研究进展[J]. 中华疾病控制杂志, 2020, 24(12): 1459-1464.
[13] He, X., Eddy, J.J., Jacobson, K.R., Henderson, A.J. and Agosto, L.M. (2020) Enhanced Human Im-munodeficiency Virus-1 Replication in CD4+ T Cells Derived from Individuals with Latent Mycobacterium tuberculosis Infection. The Journal of Infectious Diseases, 222, 1550-1560. [Google Scholar] [CrossRef] [PubMed]
[14] Bruchfeld, J., Correia-Neves, M. and Källenius, G. (2015) Tuberculosis and HIV Coinfection: Table 1. Cold Spring Harbor Perspectives in Medicine, 25, 171-178. [Google Scholar] [CrossRef] [PubMed]
[15] 王梅青, 刘建业, 张世喆. 结核分枝杆菌复合HIV感染患者Th1/Th2型炎症标志物水平的研究[J]. 临床肺科杂志, 2018, 23(7): 1183-1186.
[16] Ellwanger, J.H., Kaminski, V.D.L., Rodrigues, A.G., Kulmann-Leal, B. and Chies, J.A.B. (2020) CCR5 and CCR5Δ32 in Bacterial and Parasitic Infections: Thinking Chemokine Receptors outside the HIV Box. International Journal of Immunogenetics, 47, 261-285. [Google Scholar] [CrossRef] [PubMed]
[17] 李雨薇, 李侠. 艾滋病/结核病双重感染流行现状与研究进展[J]. 中外医学研究, 2022, 20(16): 181-184.
[18] Toossi, Z., Hirsch, C.S., Wu, M., et al. (2011) Distinct Cytokine and Regulatory T Cell Profile at Pleural Sites of Dual HIV/Tuberculosis Infection Compared to That in the Systemic Circulation. Clinical & Experimental Immunology, 163, 333-338. [Google Scholar] [CrossRef] [PubMed]
[19] Grover, A. and Izzo, A.A. (2012) BAT3 Regulates Mycobacterium tuberculosis Protein ESAT-6-Mediated Apoptosis of Macro-phages. PLOS ONE, 7, e40836. [Google Scholar] [CrossRef] [PubMed]
[20] Garcia-Bates, T.M., Palma, M.L., Anderko, R.R., et al. (2021) Dendritic Cells Focus CTL Responses toward Highly Conserved and Topologically Important HIV-1 Epitopes. EBioMedicine, 63, Article ID: 103175. [Google Scholar] [CrossRef] [PubMed]
[21] 李黎, 陶利, 钟雪梅, 杨博逸. 艾滋病与结核病共患机制研究进展[J]. 中国当代医药, 2022, 29(30): 31-34.
[22] 中华医学会热带病与寄生虫学分会艾滋病学组. 人类免疫缺陷病毒/艾滋病患者合并非结核分枝杆菌感染诊治专家共识[J]. 中华传染病杂志, 2019, 37(3): 167-176.
[23] 阮军, 尹恒, 寇国先, 杨成彬. 艾滋病合并肺结核259例临床分析[J]. 中国艾滋病性病, 2020, 26(5): 490-492.
[24] 孙建军, 卢洪洲. 艾滋病合并结核病的诊治近况[J]. 国际流行病学传染病学杂杂志, 2020, 47(2): 73-76.
[25] 周晛, 艾静文, 崔鹏, 等. 二代测序技术对活动性结核病患者的诊断价值[J]. 中国防痨杂志, 2018, 40(2): 153-156.
[26] 朱逸敏, 张文宏. 二代测序在脓毒血症患者病原学诊断中的应用[J]. 微生物与感染, 2018, 13(2): 97-101.
[27] Lawn, S.D., Meintjes, G., McIlleron, H., Harries, A.D. and Wood, R. (2013) Management of HIV-Associated Tuberculosis in Resource-Limited Settings: A State-of-the-Art Review. BMC Medicine, 11, Article No. 253. [Google Scholar] [CrossRef] [PubMed]
[28] 张玉华, 张国钦, 钟达, 傅衍勇. 应用Xpert MTB/RIF法对我国肺结核诊断及利福平耐药检测的Meta分析[J]. 现代预防医学, 2017, 44(12): 2116-2119, 2130.
[29] Naidoo, P., van Niekerk, M., du Toit, E., et al. (2015) Pathways to Multidrug-Resistant Tuberculosis Diagnosis and Treatment Initia-tion: A Qualitative Comparison of Patients’ Experiences in the Era of Rapid Molecular Diagnostic Tests. BMC Health Services Research, 15, Article No. 488. [Google Scholar] [CrossRef] [PubMed]
[30] 中华医学会感染病学分会艾滋病学组, 中华医学会热带病与寄生虫学分会艾滋病学组. HIV合并结核分枝杆菌感染诊治专家共识[J]. 中华临床感染病杂志, 2017, 10(2): 81-90.
[31] Hamada, Y., Ford, N., Schenkel, K. and Getahun, H. (2018) Three-Month Weekly Rifapentine plus Isoniazid for Tuberculosis Preventive Treatment: A Systematic Review. The In-ternational Journal of Tuberculosis and Lung Disease, 22, 1422-1428. [Google Scholar] [CrossRef] [PubMed]
[32] Westreich, D.J., Sanne, I., Maskew, M., et al. (2009) Tuberculosis Treatment and Risk of Stavudine Substitution in First-Line Antiretroviral Therapy. Clinical Infectious Diseases, 48, 1617-1623. [Google Scholar] [CrossRef] [PubMed]
[33] Mudzviti, T., Shamu, T., Chimbetete, C., et al. (2019) Tolerability of Isoniazid Preventive Therapy in an HIV -Infected Cohort of Paediatric and Adolescent Patients on Antiretroviral Therapy from a Resource-Limited Setting: A Retrospective Cohort Study. Drugs-Real World Outcomes, 6, 37-42. [Google Scholar] [CrossRef] [PubMed]
[34] Dheda, K., Lampe, F.C., Johnson, M.A. and Lipman, M.C. (2004) Outcome of HIV Associated Tuberculosis in the Era of Highly Active Antiretroviral Therapy. Journal of Infectious Dis-eases, 190, 1670-1676. [Google Scholar] [CrossRef] [PubMed]
[35] 中华医学会感染病学分会艾滋病丙型肝炎学组, 中国疾病预防控制中心. 中国艾滋病诊疗指南(2018年版) [J]. 中华内科杂志, 2018, 57(12): 867-884.
[36] Onyebujoh, P., Zumla, A., Ri-beiro, I., et al. (2005) Treatment of Tuberculosis: Present Status and Future Prospects. Bulletin of the World Health Or-ganization, 83, 857-865.
[37] Pettit, A.C., Shepherd, B.E. and Sterling, T.R. (2018) Treatment of Drugsusceptible Tu-berculosis among People Living with Human Immunodeficiency Virus Infection: An Update. Current Opinion in HIV and AIDS, 13, 469-477. [Google Scholar] [CrossRef
[38] Nahid, P., Mase, S.R., Migliori, G.B., et al. (2019) Treat-ment of Drug Resistant Tuberculosis. An Official ATS/CDC/ERS/IDSA Clinical Practice Guideline. American Journal of Respiratory and Critical Care Medicine, 200, e93-e142. [Google Scholar] [CrossRef
[39] Mallikaarjun, S., Wells, C., Petersen, C., et al. (2016) Delamanid Coad Ministered with Antiretroviral Drugs or Antituberculosis Drugs Shows No Clinically Relevant Drug-Drug Interactions in Healthy Subjects. Antimicrob Agents Chemother, 60, 5976-5985. [Google Scholar] [CrossRef
[40] 中华医学会结核病学分会. 中国耐多药和利福平耐药结核病治疗专家共识(2019年版) [J]. 中华结核和呼吸杂志, 2019, 42(10): 733-749.
[41] Rae, J.M., Johnson, M.D., Lippman, M.E. and Flockhart, D.A. (2001) Rifampin Is a Selective, Pleiotropic Inducer of Drug Metabolism Genes in Human Hepatocytes: Studies with cDNA and Oligonucleotide Expression Arrays. Journal of Pharmacology and Experimental Therapeutics, 299, 849-857.
[42] Maartens, G., Decloedt, E. and Cohen, K. (2009) Effectiveness and Safety of An-tiretrovirals with Rifampicin: Crucial Issues for High-Burden Countries. Antiviral Therapy, 14, 1039-1043. [Google Scholar] [CrossRef
[43] Li, A.P., Reith, M.K., Rasmussen, A., et al. (1997) Primary Human Hepatocytes as a Tool for the Evaluation of Structure-Activity Relationship in Cytochrome P450 Induction Potential of Xenobiotics: Evaluation of Rifampin, Rifapentine and Rifabutin. Chemico-Biological Interactions, 107, 17-30. [Google Scholar] [CrossRef
[44] Davies, G.R., Cerri, S. and Richeldi, L. (2007) Rifabutin for Treating Pulmonary Tuberculosis. Cochrane Database of Systematic Reviews, No. 4, Article ID: Cd005159. [Google Scholar] [CrossRef
[45] Gonzalez-Montaner, L.J., Natal, S., Yongchaiyud, P., et al. (1994) Rifabutin for the Treatment of Newly-Diagnosed Pulmonary Tuberculosis: A Multinational, Randomized, Com-parative Study versus Rifampicin. Tubercle and Lung Disease, 75, 341-347. [Google Scholar] [CrossRef] [PubMed]
[46] Boulle, A., Van Cutsem, G., Cohen, K., et al. (2008) Out-comes of Nevirapine- and Efavirenz-Based Antiretroviral Therapy When Coadministered with Rifampicin-Based An-titubercular Therapy. JAMA, 300, 530-539. [Google Scholar] [CrossRef] [PubMed]
[47] López-Cortés, L.F., Ruiz-Valderas, R., Viciana, P., et al. (2002) Pharmacokinetic Interactions between Efavirenz and Rifampicin in HIV-Infected Patients with Tuberculosis. Clinical Pharmacokinetics, 41, 681-690. [Google Scholar] [CrossRef] [PubMed]
[48] Cohen, K. and Meintjes, G. (2010) Management of Indi-viduals Requiring Antiretroviral Therapy and TB Treatment. Current Opinion in HIV and AIDS, 5, 61-69. [Google Scholar] [CrossRef
[49] Gulick, R.M., Ribaudo, H.J., Shikuma, C.M., et al. (2004) Triple-Nucleoside Regimens versus Efavirenz -Containing Regimens for the Initial Treatment of HIV-1 Infection. The New England Journal of Medicine, 350, 1850-1861. [Google Scholar] [CrossRef
[50] Puri, P., Kaur, N., Pathania, S., et al. (2017) Antitubercular Therapy Induced Liver Function Tests Abnormalities in Human Immunodeficiency virus Infected Individuals. Medical Journal Armed Forces India, 73, 12-17. [Google Scholar] [CrossRef] [PubMed]
[51] Dawra, S., Mandavdhare, H.S., Singh, H., et al. (2019) Ex-tra-Abdominal Involvement Is Associated with Antitubercular Therapy-Related Hepatitis in Patients Treated for Ab-dominal Tuberculosis. Clinical and Experimental Hepatology, 5, 60-64. [Google Scholar] [CrossRef] [PubMed]
[52] 中华医学会结核病学分会. 抗结核药物性肝损伤诊治指南(2019年版) [J]. 中华结核和呼吸杂志, 2019, 42(5): 343-356.
[53] Schutz, C., Meintjes, G., Almajid, F., Wilkinson, R.J. and Pozniak, A. (2010) Clinical Management of Tuberculosis and HIV-1 Coinfection. European Respiratory Journal, 36, 1460-1481. [Google Scholar] [CrossRef] [PubMed]