1、 Chin J Tuberc Respir Dis,2002.Yu,et al.Chin J Lab Med,2009 Incidence of death among persons with HIV/AIDSPer 100-person YearsYear of Diagnosis 72%p .0001 *2009 MMWRIn low HIV prevalence area:HIV positivity rate in TB patients=5-10 times of HIV prevalence in general population 低低HIV流行区流行区:活动性结核患者的活动
2、性结核患者的HIV阳性率阳性率 人群人群HIV患病率患病率 x（5-10）倍）倍在不同状态下结核病的症状和体征症状/体征HIV 阳性(%)HIV 阴性(%)呼吸困难发热盗汗体重下降腹泻肝肿大脾肿大淋巴结肿大9779838923414035816264834211513Chest 1994;106:1471-6 结核发生的类型（部位）SiteHIV positive(%)HIV negative(%)肺肺外两者胸膜心包淋巴结4034263115197216121933J Trop Med Hygiene 1993;96:1-110.700.750.800.850.900.951.00Surviv
3、alSurvivalMonths PostrandomizationMonths Postrandomization012345678910 11 12 13 14 15 16 17 18 19 20 21 22 23 24Intensive Intensive phase phase of TB of TB treatmenttreatmentPost-TB treatmentPost-TB treatmentContinuationContinuationphase of TB phase of TB treatmenttreatmentEarly ARTSequential ARTSta
4、rting Antiretroviral therapy(ART)in three Points In Tuberculosis therapy Abdool Karim SS,et al.CROI 2009.Abstract 36a.55%reduction 55%reduction in mortalityin mortalityEstimates of being TB free in the Haiti CIPRA Estimates of being TB free in the Haiti CIPRA trialtrial18 New TB cases in immediate a
5、nd 36 in deferred(2X)21.5 7.8%P=0.003,log-rank 8.3 5.9%CD4100,twice-weeklyCD4100Mechanisms of Drug Interactions Involving Antituberculosis DrugsMechanismExamplesEffect onother drugsClinicaleffectP450 InductionP450 InhibitionBinding in the GI tractRIF RPT RBTRTV NLV,IDV SQVAntacids(DDI),Fe,Zn levels
6、levels levels efficacy toxicity efficacyEffect of rifamycins on serum concentrations(AUC)of protease inhibitorsRifabutinRifampinPISaquinavirRitonavirIndinavirNelfinavirAmprenavirLopinavir/ritonavirAtazanavir 46%NR 24%0-23%14%No effectNo effect 80%35%90%82%81%75%not doneEffect of protease inhibitors
7、on serum concentrations(AUC)of rifamycins RifabutinRifampinPISaquinavirRitonavirIndinavirNelfinavirAmprenavirLopinavir/ritonavirAtazanavir 45%400%270%200%400%300%250%NRunchangedNRNRNRNRNREffect of rifamycins on serum concentrations(AUC)of NNRTIsNNRTIRifabutinRifampinNevirapine 16%37%Delavirdine 80%9
8、6%Efavirenzunchanged 13%Overlapping side effect profiles of first-lineantituberculosis drugs and antiretroviral drugsSide effectPossible causesAntituberculosis drugsAntiretroviral drugsSkin rashNausea,vomitingHepatitsLeukopenia,anemiaPZA,INHPZA,RBT,INHPZA,RBT,INHRBTNVP,DVL,EFV,ABCAZT,AMP,IDVNVP,PIs,immunereconstitutionAZT%人有了知识，就会具备各种分析能力，明辨是非的能力。所以我们要勤恳读书，广泛阅读，古人说“书中自有黄金屋。”通过阅读科技书籍，我们能丰富知识，培养逻辑思维能力；通过阅读文学作品，我们能提高文学鉴赏水平，培养文学情趣；通过阅读报刊，我们能增长见识，扩大自己的知识面。有许多书籍还能培养我们的道德情操，给我们巨大的精神力量，鼓舞我们前进。
