HIV与 MDR-TB双重感染.pptVIP

交叉或累加毒性 交叉或累加毒性 药物相互作用 去羟基苷（使用肠溶制剂）抗酸和含有缓冲碱的药物 使用EC-ddI 代替含有缓冲碱的ddI，因为需要胃酸才能吸收的药物如喹诺酮类抗生素等，在和这些药物联合应用时，应该在服用ddI 前或后1～2 小时应用，如果使用ddI 肠溶（EC）制剂将不需要这些限制。 克拉霉素和细胞色素酶P450同工酶（CYP3A）诱导剂避免同时使用：潜在致命性 克拉霉素和齐多夫定（AZT）：口服克拉霉素与齐多夫定会引起齐多夫定稳态血浓度下降，这主要是由于克拉霉素会干扰齐多夫定的吸收，故错开服用时间可避免这种影响，但无需调整剂量 HIV的流行会加重MDR-TB的流行吗？ 可怕的风暴：MDR-TB和HIV HIV流行如何加重MDR-TB的流行？ 院内感染 吸收不良 利福平获得性耐药 治疗效果差 HIV会使得结核病发病率上升，破坏结核病控制规划取得的效果 南非和东非的教训 *Ordway DJ et al. Infect Immun. 1995;63(2):741-3 未来行动优先领域 对敏感性结核病患者和MDR-TB患者的正确管理 快速适宜的HIV及耐药疫情的调查和监测 HIV高流行地区 MDR-TB高流行地区 高危人群（医院、学校） 实验室能力建设 感染控制 抗逆转录病毒药物对HIV/MDR-TB感染者的重要性 HIV和MDR间的关系 出现两者同时流行的灾难性局面的可能性 进一步耐药的可能性 治疗的复杂性 预防的必要性 HIV和TB联合控制的必要性 总结 * This slide that contains all essential numbers WHO estimates that worldwide in 2007 over 9 million TB cases occurred (and of those, 4 million infectious, sputum-smear (+)). 1.65 million people died of TB, which means 4500 every day. WHO estimates, based on surveys conducted in over 110 settings in the last decade, that nearly half a million cases are multi-drug resistant, and 130,000 of them lethal WHO estimates that XDR-TB cases, which are resistant to all most potent first-line and second-line, reserve drugs, were about 50,000, the majority of which are lethal. Finally, well over 700,000 cases of the 9 million are linked with HIV/AIDS. This is slightly less than 10%. In Africa, this % is much higher, up to50%. In the rest of the world, however, the vast majority of TB cases are not due to HIV. * * * * * * * This table presents an example of the implications of nosocomial transmission on the global MDR TB and HIV epidemic. This slide shows data from the multiple outbreaks of MDR TB in the US in the late 1980’s and early 1990’s in hospitals, prisons, and other congregate settings demonstrates the link between mortality from MDR TB and infection with HIV. In nearly all but 1 of the outbreaks (hosp E), the HIV seroprevalence among MDR TB cases exceeded 80%, and the median interval from initiation of therapy to death was less than