Эффективность и безопасность лечения ВИЧ-ассоциированного туберкулеза с множественной лекарственной устойчивостью. Систематический обзор и мета-анализ

Цель: систематический обзор и мета-анализ публикаций, оценивающих влияние ВИЧ-инфекции на исходы лечения и развитие неблагоприятных побочных реакций у больных туберкулезом с множественной лекарственной устойчивостью возбудителя.

Материалы и методы: выполнен поиск публикаций по заданным ключевым словам в электронных базах MEDLINE (PubMed), Google Scholar и eLibrary. Для мета-анализа отобраны 27 публикаций с суммарным количеством пациентов 13 944. Мета-анализ проведен с помощью программного обеспечения Review Manager (RevMan версии 5.4; Cochrane Collaboration, Оксфорд, Великобритания). Проверку статистической неоднородности исследований осуществляли с помощью Q-теста на основе χ2. Эффект считался статистически значимым при p<0,05.

Результаты: по данным проведенного мета-анализа установлено, что частота неблагоприятных исходов у пациентов с коинфекцией МЛУ-ТБ/ВИЧ превышала аналогичный показатель в группе без ВИЧ и составила 37%, ОШ=1,49 [ДИ: 1,15–1,93], частота летальных исходов – 20,3%, ОШ=2,02 [95% ДИ: 1,64–2,49]. Среди ВИЧ-инфицированных отмечалась более высокая частота развития нежелательных побочных реакций: ОШ=1,51 [95% ДИ: 1,01–2,26], нежелательных побочных реакций тяжелой степени тяжести: ОШ=1,53 [95% ДИ: 1,1–2,13].

Заключение: результаты мета-анализа показывают, что пациенты с коинфекцией МЛУ-ТБ/ВИЧ характеризуются повышенной частотой неблагоприятных исходов и риском развития любых неблагоприятных побочных реакций, необходим дальнейший анализ проблемы с целью оптимизации результатов лечения среди данной категории населения.

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