背景:晚期HIV疾病(AHD)正在增加,晚期就诊占欧洲新诊断HIV(PWH)患者的一半。晚期PWH的死亡率仍然很高,和鸟分枝杆菌复合体(MAC)病,在其他机会性感染中,提出了几个导致诊断和治疗的挑战,最终,临床结果不佳。
目的:我们旨在为PWH播散性MAC病(dMACd)的诊断和治疗提供指导。
方法:我们对原始文章进行了回顾,荟萃分析,以及从PubMed检索的系统评价。
背景:我们回顾并讨论了使用AHD和dMACd治疗PWH的最具挑战性的步骤:有效抗逆转录病毒治疗(ART)时代的当前流行病学;在其他机会性感染和免疫重建的背景下的临床表现和症状解释;诊断,采样,以及确定诊断的时机;预防,治疗方案,以及停止MAC治疗的迹象;未来的观点,以及利福霉素在dMACd治疗中的作用。
结论:尽管广泛使用有效的ART,dMACd仍然是PWH伴AHD发病和死亡的主要原因。剩余的挑战主要与达成明确诊断所需的困难和时机有关,关于利福霉素在dMACd治疗中的作用的讨论仍在进行中。
BACKGROUND: Advanced HIV disease (AHD) is increasing, with late presentation accounting for half of newly diagnosed people with HIV (PWH) in Europe. Mortality in late-presenting PWH remains high, and Mycobacterium avium complex (MAC) disease, among other opportunistic infections, presents several diagnostic and treatment challenges that lead, ultimately, to a poor clinical outcome.
OBJECTIVE: We aimed to provide guidance on the diagnosis and treatment of disseminated MAC disease (dMACd) in PWH.
METHODS: We performed a review of original articles, meta-analyses, and systematic reviews retrieved from PubMed.
BACKGROUND: We reviewed and discussed the most challenging steps in the management of PWH with AHD and dMACd: the current epidemiology in the era of effective antiretroviral treatment (ART); clinical presentation and interpretation of symptoms in the context of other opportunistic infections and immune reconstitution; diagnosis, sampling, and timing to reach a definitive diagnosis; prophylaxis, treatment options, and indications for discontinuing MAC treatment; future perspectives, and the role of rifamycins in the treatment of dMACd.
CONCLUSIONS: Despite the widespread availability of effective ART, dMACd still represents a major cause of morbidity and mortality in PWH with AHD. Residual challenges are mainly related to the difficulties and timing required to reach a definitive diagnosis, and the discussion regarding the role of rifamycins in the treatment of dMACd is still open.