Experts’ consensus on the diagnosis and treatment of patients with spinal tuberculosis complicated with HIV/AIDS

doi:10.3969/j.issn.1000-6621.2020.05.002

Abstract

Abstract:

Patients with spinal tuberculosis complicated with HIV/AIDS have multiplied the difficulty of treatment due to low immune function. To standardize the procedures for diagnosis and treatment in patients with spinal tuberculosis complicated with HIV/AIDS, and to increase peer awareness of the details of the treatment of such diseases, and to have a reliable basis for their treatment, we organized the Professional Branch of Chinese Antituberculosis Association, the Western China Bone Tuberculosis Alliance, the North China Bone Tuberculosis Alliance and the Editorial Board of Chinese Journal of Antituberculosis to jointly develop the experts’ consensus on the diagnosis and treatment of patients with spinal tuberculosis complicated with HIV/AIDS. Some items including the epidemiological background, the common clinical manifestations, laboratory examination, diagnostic criteria, drugs usage, surgical treatment, occupational exposure during surgery,announcements and relative research have been formulated and discussed on these patients with spinal tuberculosis complicated with HIV/AIDS in this experts’ consensus.

Key words: Tuberculosis,spinal, HIV infections, Acquired immunodeficiency syndrome, Diagnosis, Treatment, Consensus

The Joint Tuberculosis Professional Branch of Chinese Antituberculosis Association, the Western China Bone Tuberculosis Alliance, the North China Bone Tuberculosis Alliance, Editorial Board of Chinese Journal of Antituberculosis. Experts’ consensus on the diagnosis and treatment of patients with spinal tuberculosis complicated with HIV/AIDS[J]. Chinese Journal of Antituberculosis, 2020, 42(5): 418-424. doi: 10.3969/j.issn.1000-6621.2020.05.002

References 33

[1]	World Health Organization . Global tuberculosis report 2018. Geneva: World Health Organization, 2018.
[2]	沈银忠, 卢洪洲 . 艾滋病合并结核病诊治现状. 中国实用内科杂志, 2015,35(8):671-674.
[3]	中华医学会感染病学分会艾滋病丙型肝炎学组, 中国疾病预防控制中心. 中国艾滋病诊疗指南(2018年版). 中华内科杂志, 2018,57(12):867-884.
[4]	中国疾病预防控制中心性病艾滋病预防控制中心. 全国艾滋病检测技术规范(2015年修订版). 北京:中国疾病预防控制中心, 2015.
[5]	US Preventive Services Task Force, Owens DK, Davidson KW , et al. Screening for HIV infection: US Preventive Servi-ces Task Force recommendation statement. JAMA, 2019,321(23):2326-2336. doi: 10.1001/jama.2019.6587 URL pmid: 31184701
[6]	荆凡辉, 吕玮, 李太生 . HIV感染者免疫功能重建新视角:CD4/CD8比值. 中国艾滋病性病, 2018,24(6):643-644,封三-封四.
[7]	中华医学会感染病学分会艾滋病学组, 中华医学会热带病与寄生虫学分会艾滋病学组. HIV合并结核分枝杆菌感染诊治专家共识. 中华临床感染病杂志, 2017,10(2):81-90.
[8]	Kaplan JE, Benson C, Holmes KK , et al. Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. MMWR Recomm Rep, 2009,58(RR-4):1-207. URL pmid: 19357635
[9]	吕飞, 张明明, 郑莉 , 等. 2012—2015年成都市公共卫生临床医疗中心HIV感染者Ⅰ类切口手术抗菌药物的使用情况分析. 现代药物与临床, 2017,32(4):733-736.
[10]	孙胜, 张耀申, 张强 , 等. 围手术期辅助治疗对骨科人类免疫缺陷病毒感染者术后伤口愈合的影响. 中华医学杂志, 2014,94(29):2269-2273.
[11]	刘保池, 刘立, 杨昌明 , 等. 艾滋病病毒感染者手术后脓毒症的救治. 中华临床医师杂志(电子版), 2011,5(9):2742-2744.
[12]	Feng T, Feng X, Jiang C , et al. Sepsis risk factors associated with HIV-1 patients undergoing surgery. Emerg Microbes Infect, 2015,4(9):e59. doi: 10.1038/emi.2015.59 URL pmid: 26954996
[13]	赵汝岗, 赵昌松, 李鑫 , 等. 人类免疫缺陷病毒阳性青年男性患者四肢闭合骨折内固定术后切口延迟愈合影响因素的研究. 中国矫形外科杂志, 2017,25(2):114-118.
[14]	严广璇, 秦世炳, 董伟杰 , 等. 胸椎结核病变活动型合并截瘫患者手术疗效分析. 中国防痨杂志, 2015,37(3):223-229. doi: 10.3969/j.issn.1000-6621.2015.03.002 URL
[15]	李元, 秦世炳, 董伟杰 , 等. 老年脊柱结核伴截瘫患者的手术时机与疗效分析. 中国防痨杂志, 2015,37(3):223-229. doi: 10.3969/j.issn.1000-6621.2015.03.002 URL
[16]	Guild GN, Moore TJ, Barnes W , et al. CD4 count is associated with postoperative infection in patients with orthopaedic trauma who are HIV positive. Clin Orthop Relat Res, 2012,470(5):1507-1512. doi: 10.1007/s11999-011-2223-1 URL pmid: 22207561
[17]	刘立, 刘保池 . CD4 T淋巴细胞计数与HIV感染者手术风险评估. 中华全科医学, 2011,9(1):7-8.
[18]	Deneve JL, Shantha JG, Page AJ , et al. CD4 count is predictive of outcome in HIV-positive patients undergoing abdominal operations. Am J Surg, 2010,200(6):694-699; discussion 699-700. doi: 10.1016/j.amjsurg.2010.07.030 URL pmid: 21146004
[19]	Kigera JW, Straetemans M, Vuhaka SK , et al. Is there an increased risk of post-operative surgical site infection after orthopaedic surgery in HIV patients? A systematic review and meta-analysis. PLoS One, 2012,7(8):e42254. doi: 10.1371/journal.pone.0042254 URL pmid: 22905120
[20]	Hassan K, Elmorshidy E . Anterior versus posterior approach in surgical treatment of tuberculous spondylodiscitis of thoracic and lumbar spine. Eur Spine J, 2016,25(4):1056-1063. doi: 10.1007/s00586-016-4451-2 URL pmid: 26922735
[21]	王志华, 舒钧, 任莉荣 , 等. 不同入路内固定手术对老年胸腰椎结核患者脊柱后凸畸形矫正效果的影响. 颈腰痛杂志, 2018,39(6):721-724.
[22]	刘思源, 窦吉辰, 饶涛 , 等. 术前穿刺置管冲洗引流联合手术治疗复发性脊柱结核的效果分析. 中国防痨杂志, 2019,41(4):457-462.
[23]	阿布都艾尼·米吉提. 脊柱结核的手术治疗研究进展. 医学信息, 2018,31(1):64-66.
[24]	Kumakech E, Achora S, Berggren V , et al. Occupational exposure to HIV: a conflict situation for health workers. Int Nuts Rev, 2011,58(4):454-462. doi: 10.1111/j.1466-7657.2011.00887.x URL pmid: 22092324
[25]	Traynor K . Revised guidelines for occupational HIV exposure include simpler regimens. Am J Health Syst Pharm, 2013, 70(19): 1642,1246. doi: 10.2146/news130067 URL pmid: 24048593
[26]	马淑焕 . 脊柱结核的护理//中华护理学会.中华护理学会第11届全国骨科护理学术交流暨专题讲座会议论文汇编. 北京:中华护理学会, 2009: 259-261.
[27]	Sandher DS, Al-Jibury M, Paton RW , et al. Bone and joint tuberculosis: cases in Blackburn between 1988 and 2005. J Bone Joint Surg Br, 2007,89(10):1379-1381. doi: 10.1302/0301-620X.89B10.18943 URL pmid: 17957082
[28]	do Amaral SH, Silva MN, Giraldi M , et al. Intravertebral abscess in a patient with spinal tuberculosis. J Neurosurg Spine, 2009,10(2):160. doi: 10.3171/2008.11.SPI17678 URL pmid: 19278331
[29]	Dunn R, Zondagh I, Candy S . Spinal tuberculosis: magnetic resonance imaging and neurological impairment. Spine(Phila Pa 1976), 2011,36(6):469-473.
[30]	Kaila R, Malhi AM, Mahmood B , et al. The incidence of multiple level noncontiguous vertebral tuberculosis detected using whole spine MRI. J Spinal Disord Tech, 2007,20(1):78-81. doi: 10.1097/01.bsd.0000211250.82823.0f URL pmid: 17285057
[31]	Kobayashi N, Fraser TG, Bauer TW , et al. The use of real-time polymerase chain reaction for rapid diagnosis of skeletal tuberculosis. Arch Pathol Lab Med, 2006,130(7):1053-1056. doi: 10.1043/1543-2165(2006)130[1053:TUORPC]2.0.CO;2 URL pmid: 16831035
[32]	van Zyl-Smit RN, Pai M, Peprah K , et al. Within-subject variability and boosting of T-cell interferon-gamma responses after tuberculin skin testing. Am J Respir Crit Care Med, 2009,180(1):49-58. doi: 10.1164/rccm.200811-1704OC URL pmid: 19342414
[33]	Boehme CC, Nabeta P, Hillemann D , et al. Rapid molecular detection of tuberculosis and rifampin resistance. N Engl J Med, 2010,363(11):1005-1015. doi: 10.1056/NEJMoa0907847 URL pmid: 20825313