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同时使用结核病和艾滋病毒疗法可以控制共感染期间的结核病复激活,但不能控制慢性免疫激活

Riti Sharan¹, Yi Zou², Bindu Singh^3,4

¹Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, TX, USA. rsharan@txbiomed.org.

Nature communications

|December 12, 2025

概括

与抗逆转录病毒疗法 (cART) 和抗结核药物 (3HP) 的联合治疗改善了潜伏结核感染和HIV联合感染的的结局,但没有完全恢复对Mycobacterium结核病的肺免疫力.

科学领域:

免疫学免疫学免疫学
传染性疾病传染性疾病
艾滋病毒/艾滋病研究研究

背景情况:

艾滋病毒同时感染显著增加结核病 (TB) 的进展,尽管结合抗逆转录病毒疗法 (cART).
肺免疫缺陷,包括扭曲的CD4+T细胞反应,在cART治疗的HIV阳性个体中持续存在,导致持续的结核病风险.
目前的治疗方法无法在同时感染的个体中完全恢复Mycobacterium结核病 (Mtb) 的免疫控制.

研究的目的:

评估与cART同时进行的抗结核病治疗 (3HP) 的有效性,以改善共感染模型中的细菌控制和免疫恢复.
研究同步cART+3HP对肺免疫反应和结核病病变解决的影响.

主要方法:

患有潜在结核病感染 (LTBI) 和类似免疫缺陷病毒 (SIV) 联合感染的 rhesus macaques (RM) 接受了每日cART和三个月的每周异化和利法丁 (3HP) 治疗.
评估了临床,微生物学和免疫学结局,包括T细胞反应和颗粒瘤特征.

主要成果:

与单独使用cART相比,同时使用cART+3HP治疗改善了临床和微生物学结果.
然而,治疗未能完全恢复肺 CD4 + T 细胞免疫力,由持续的状颗粒瘤,高FDG吸收和不完全的T 细胞复合证明.
具体的免疫缺陷包括持续的CD4+T细胞激活,疲劳,炎症和效应器记忆 (T_EM) CD4+T细胞的耗尽.

结论:

同时的cART+3HP疗法显示部分疗效,但不能解决HIV-Mtb同时感染的持续性肺免疫缺陷.
持续性免疫功能障碍凸显了对宿主指导的辅助疗法的需要,以改善艾滋病毒感染者结核病控制.
需要进行进一步的研究,以确定可以在同时感染的个体中完全恢复对Mtb的保护性免疫力的治疗点.

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