HIV-TB合并感染患者ART治疗时机对治疗结局影响的Meta分析  

Effect of ART treatment timing on treatment outcomes in HIV-TB Co-infected patients:A Meta-analysis

作　　者：于洁 马蕊 杨海群 黄舒骏 石洪達 夏岚[2] 伍敏 陈斌 张韬[1] 廖如珺[2] YU Jie;MA Rui;YANG Haiqun;HUANG Shujun;SHI Hongda;XIA Lan;WU Min;CHEN Bin;ZHANG Tao;LIAO Rujun(West China School of Public Health,Sichuan University/West China Fourth Hospital,Chengdu 610041,Sichuan Province,China;Sichuan Center for Disease Control and Prevention,Chengdu 610041,Sichuan Province,China;Butuo County People’s Hospital,Liangshan Prefecture 616300,Sichuan Province,China)

机构地区：[1]四川大学华西公共卫生学院/四川大学第四医院,成都610041 [2]四川省疾病预防控制中心,成都610041 [3]布拖县人民医院,四川布拖616300

出　　处：《预防医学情报杂志》2023年第7期735-746,共12页Journal of Preventive Medicine Information

基　　金：四川省科技计划基金项目(项目编号:2022YFS0229);凉山州科技计划重点研发项目(项目编号:22ZDYF0125)。

摘　　要：目的 探索艾滋病病毒-结核病(HIV-TB)合并感染患者抗逆转录病毒治疗(ART)启动时机对全因死亡率、免疫重建炎症综合征(IRIS)发生率和治疗成功率的影响。方法 检索知网、万方、维普、EMbase、Medline和PubMed共6个数据库,收集2012年1月至2021年12月发表的关于ART启动时间对HIV-TB合并感染患者治疗结局影响的相关队列研究。由2名研究者独立检索文献,3名研究者独立进行文献筛选,2名研究者独立对纳入文献进行质量评价,采用RevMan 5.3软件进行Meta分析。结果 共纳入24项队列研究,16 608例患者。Meta分析结果显示:①ATT之前启动ART和之后启动(95%CI:0.98~1.92)、启动≤4周和>4周(95%CI:0.56~2.20)、启动≤8周和>8周(95%CI:0.51~1.34)患者死亡率差异无统计学意义,ART启动≤2周比>2周患者死亡率高(95%CI:1.01~1.80);②ATT之前和之后启动ART(95%CI:0.33~1.55)、启动≤8周和>8周(95%CI:0.84~10.96)患者的IRIS发生率无统计学差异;③ATT之前启动ART比之后启动的治疗成功率低(95%CI:0.90~0.97)。结论 ATT之前启动ART比之后启动ART时患者的死亡率高,治疗成功率低,ATT后不同时机启动ART其死亡率也存在较大差异,而与IRSI发生率无关。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。Objective To explore the effect of initiation time of antiretroviral therapy(ART)on all-cause mortality,incidence of immune reconstitution inflammatory syndrome(IRIS)and treatment success rate in HIV-TB(human immunodeficiency virus-tuberculosis)co-infected patients.Methods Six databases including CNKI,Wanfang,VIP,EMbase,Medline and PubMed were searched to collect cohort studies on the effect of ART initiation time on the treatment outcomes of HIV-TB co-infected patients published from January 2012 to December 2021.Two researchers searched literature independently,three researchers screened literature independently,and two researchers assessed the quality of included studies independently.A meta-analysis was performed by RevMan 5.3 software.Results A total of 24 studies were included,involving 16608 patients.The results of meta-analysis showed that:①There was no significant difference in the mortality rate between the patients started ART before and after ATT(anti-tuberculosis treatment)(95%confidence interval CI:0.98-1.92),started≤4 weeks and>4 weeks(95%CI:0.56-2.20),and started≤8 weeks and>8 weeks(95%CI:0.51-1.34).The mortality rate of patients started ART≤2 weeks was higher than that of patients started ART>2 weeks(95%CI:1.01-1.80).②There was no significant difference in the incidence of IRIS between patients started ART before and after ATT(95%CI:0.33-1.55),started ART≤8 weeks and>8 weeks(95%CI:0.84-10.96).③The success rate of ART before ATT was higher than that after ATT(95%CI:0.90-0.97).Conclusions Patients started ART before ATT had higher mortality rate and lower treatment success rate than those of patients started ART after ATT.The mortality rate of ART started at different time after ATT was also significant different,which was not related to the incidence of IRIS.Due to the limited quantity and quality of the included studies,more high-quality studies are needed to verify the above conclusion.

关 键 词：艾滋病 结核病 抗逆转录病毒治疗 META分析 队列研究 

分 类 号：R512.91[医药卫生—内科学] R521[医药卫生—临床医学]