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在消耗酒精的艾滋病毒阳性患者中,对异化预防性治疗的策略
A Savinkina1, W Muyindike2, J A Hahn3
1Public Health Modeling Unit, and the, Epidemiology of Microbial Diseases Department, Yale School of Public Health, New Haven, CT, USA.
概括
在高结核病负担地区,建议对艾滋病毒感染者服用酒精的艾滋病毒感染者进行伊索尼亚预防疗法 (IPT). 即使没有定期的肝酶监测,IPT对于预防结核病 (TB) 也比不治疗更安全.
科学领域:
- 公共卫生 公共卫生
- 传染性疾病 传染性疾病
- 临床医学 临床医学
背景情况:
- 世卫组织的指导方针建议,由于肝毒性风险,在经常饮酒的人群中,不提供异化预防疗法 (IPT).
- 这份指南可能无意中排除了许多在高负担环境中患结核病 (TB) 风险较高的艾滋病毒感染者 (PLWH).
研究的目的:
- 评估结核病预防治疗 (TPT) 的安全性和有效性,在报告酒精使用的PLWH中.
- 在乌干达10年期间,评估与IPT相关的肝毒性风险.
主要方法:
- 开发了一个马尔科夫模型来模拟潜在的结核病感染,IPT和结核病进展.
- 来自饮酒者暴露于结核病预防治疗 (ADEPTT) 研究的数据为模型提供了信息.
- 场景包括没有IPT,IPT与肝酶监测 (AST/ALT) 和IPT与结核素皮肤测试 (TST) 预选.
主要成果:
- 没有IPT的情景导致10年内每10万人口中有230例结核病死亡.
- 所有的IPT场景都显示出比没有IPT更好的结果.
- 当结核病发病率超过每10万人中50人时,即使没有监测,IPT也受到IPT的青.
结论:
- 在结核病流行地区饮酒的PLWH应提供IPT,最好定期监测AST/ALT.
- 尽管存在潜在的监测局限性,但IPT仍然是预防这一群体结核病的首选策略,而不是没有治疗.
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