婴儿、儿童和 15 岁以下青少年中与艾滋病毒相关的结核病:流行病学、诊断、预防和治疗方面的最新情况。

Juanita Lishman, Lisa J Frigati, Helena Rabie
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引用次数: 0

摘要

审查目的:艾滋病毒相关结核病(TB)仍然是 15 岁以下儿童和青少年(CLWH)发病和死亡的主要原因。本综述旨在重点介绍在预防、诊断和治疗儿童和青少年艾滋病相关结核病方面的最新发现,并强调知识和实施方面的差距:我们发现,尽管可以使用抗逆转录病毒疗法(ART),但仍有报道称艾滋病相关结核病的发病率很高,而且死亡率高得令人无法接受。在结核病筛查方面没有取得进展,但基于利福喷丁的结核病预防疗法的疗程越来越短。在结核病诊断中使用算法有可能简化治疗决策。有更多的数据支持在使用利福平的同时使用多鲁曲韦 (DTG),而且有必要研究未经调整的 DTG,尤其是在最年幼的儿童中。目前正在对非重症肺结核实施短程治疗,应在慢性病妇女和儿童医院中研究该方案的效果。抗逆转录病毒疗法的接受率低和抑制效果差仍然是导致艾滋病相关肺结核的重要原因。小结:尽管筛查和诊断仍然具有挑战性,但在艾滋病相关肺结核的预防和治疗方面已经取得了一些进展。需要有效实施这些策略,以提高慢性病患者的治疗效果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
HIV-associated tuberculosis in infants, children, and adolescents younger than 15 years: an update on the epidemiology, diagnosis, prevention, and treatment.

Purpose of review: HIV-associated tuberculosis (TB) remains a major driver of morbidity and mortality in children and adolescents younger than 15 years (CLWH). The purpose of this review is to highlight recent findings in the areas of prevention, diagnosis, and treatment of HIV-associated TB in CLWH and to highlight knowledge and implementation gaps.

Recent findings: We found that despite access to antiretroviral therapy (ART), high rates of HIV-associated TB are still reported, and with an unacceptably high mortality. There are no advances in screening for TB, but shorter courses of rifapentine-based TB preventive therapy are becoming available. The use of algorithms in TB diagnosis can potentially simplify the therapeutic decision making. There are more data supporting the use of dolutegravir (DTG) with rifampicin and a need to study unadjusted DTG especially in the youngest children. Short course therapy for nonsevere pulmonary TB is currently implemented and programmatic outcome should be studied in CLWH. Low uptake of ART and poor suppression remains an important driver of HIV-associated TB.

Summary: Although screening and diagnosis remains challenging, there are several advances in the prevention and treatment of HIV-associated TB. Effective implementation of these strategies is needed to advance the outcomes of CLWH.

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