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- 李侗曾副主任医师
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医院:
首都医科大学附属北京佑安医院
科室:
综合感染科
- Q 热(羊流感)
- 狂犬病暴露后预防
- 霍乱诊疗常规
- 麻疹
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- 艾滋病合并结核时---尽快抗病毒治疗获益更多
- 作者:李侗曾|发布时间:2011-11-24|浏览量:904次
ART Sooner Rather Than Later
Carlos del Rio, MD
Abstract
The results of three randomized, controlled trials (SAPiT, STRIDE, and CAMELIA) demonstrate that, for coinfected patients with advanced immunosuppression, the survival benefit of starting ART within the first 2 weeks of TB therapy outweighs the risk for immune reconstitution inflammatory syndrome and other adverse events.
Introduction
Although tuberculosis (TB) is the most common AIDS-defining opportunistic infection worldwide, the timing of antiretroviral therapy (ART) in HIV/TB-coinfected patients has not been well established. Until recently, many clinicians would defer ART until the completion of TB therapy because of concerns about drug interactions, a high pill burden, and the development of immune reconstitution inflammatory syndrome (IRIS). In 2010, the initial results of the SAPiT trial showed a substantial mortality benefit from starting ART during the first 3 months of TB treatment rather than later (JWAIDS Clin Care Feb 24 2010). Based on these findings, the WHO treatment guidelines currently recommend starting ART as soon as possible after the initiation of TB therapy. Now, the final results of SAPiT, as well as two other randomized, controlled trials (all previously presented at CROI 2011 or AIDS 2010), indicate that the optimal timing of early ART initiation in HIV/TB-coinfected patients depends on baseline CD4-cell count.
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