Expert consensus on diagnosis and treatment of spinal tuberculosis with HIV/AIDS (2nd Edition)

doi:10.19982/j.issn.1000-6621.20240411

Abstract

Abstract:

Patients with spinal tuberculosis co-infected with HIV/AIDS are profoundly immunocompromised, significantly complicating their clinical management. To establish standardized protocols for diagnosing and treating this dual pathology, thereby enhancing clinical understanding and providing evidence-based treatment guidelines, the Joint Tuberculosis Professional Branch of Chinese Antituberculosis Association, in collaboration with the Western China Bone Tuberculosis Alliance, the North China Bone Tuberculosis Alliance, and the Editorial Board of Chinese Journal of Antituberculosis, formulated and released the Expert consensus on the diagnosis and treatment of patients with spinal tuberculosis complicated with HIV/AIDS in May 2020. The consensus opens with an overview of the epidemiological context of spinal tuberculosis complicated by HIV/AIDS. It provides a detailed discussion on the common clinical manifestations, laboratory diagnostic criteria, as well as pharmacological and surgical treatment options. Furthermore, it addresses critical aspects such as occupational exposures, necessary precautions during surgery, and outlines future research directions for the management of spinal tuberculosis complicated by HIV/AIDS. Building upon the first edition of the consensus, and incorporating both the clinical experience and diagnostic and therapeutic approaches for spinal tuberculosis complicated by HIV/AIDS in China, as well as relevant international research findings, the consensus writing group has jointly developed the second edition of the Expert consensus on diagnosis and treatment of spinal tuberculosis with HIV/AIDS. This updated version highlights recent epidemiological trends over the past five years, advances in preoperative antiviral therapy, and the evolving anti-tuberculosis treatment regimens for drug-resistant tuberculosis. The consensus also discusses the advancements in minimally invasive surgery for the treatment of spinal tuberculosis complicated by HIV/AIDS, as well as the potential application of accelerated recovery surgery principles in the management of these patients. The aim is to provide clinicians with a comprehensive framework for accurate diagnosis and evidence-based treatment of spinal tuberculosis complicated by HIV/AIDS.

Key words: Tuberculosis, spinal, HIV infections, Acquired immunodeficiency syndrome, Comorbidities, Consensus development conferences as topic

CLC Number:

Expert Consensus on the Diagnosis and Treatment of Spinal Tuberculosis Combined with HIV/AIDS Patients Group, Combined with HIV/AIDS Patients Group Chinese Antituberculosis Association, Chinese Antituberculosis Association of STD and AIDS Prevention and Control, the Western China Bone Tuberculosis Alliance, the North China Bone the North China Bone. Expert consensus on diagnosis and treatment of spinal tuberculosis with HIV/AIDS (2nd Edition)[J]. Chinese Journal of Antituberculosis, 2025, 47(1): 1-11. doi: 10.19982/j.issn.1000-6621.20240411

Figures/Tables 2

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证据级别	具体描述	研究类型	表达字母
高级证据	非常确信真实的效应值接近效应估计,未来研究几乎不可能改变现有评价结果的可信度	随机对照试验;质量升高二级的观察性研究	A
中级证据	对效应估计值有中等程度的信心,真实值有可能接近估计值,但仍存在二者大小相同的可能性,未来研究可能对现有评估有重要影响,可能改变评价结果的可信度	质量降低一级的随机对照试验;质量升高一级的观察性研究	B
低级证据	对效应估计值的确信程度有限,真实值可能与估计值大不相同,未来研究很有可能对现有评估有重要影响,改变评估结果可信度的可能性较大	质量降低二级的随机对照试验;观察性研究	C
极低级证据	对效应估计值几乎没有信心,真实值很可能与估计值大不相同,任何评估都很不确定	质量降低三级的随机对照试验;质量降低一级的观察性研究;系列病例观察;个案报道	D

证据质量	推荐强度	具体描述	表达数字
高级证据	支持使用某项干预措施的强推荐	评价者确信干预措施利大于弊	1
中级证据	支持使用某项干预措施的弱推荐	利弊不确定或无论高低质量的证据均显示利弊相当	2
低级证据	反对使用某项干预措施的弱推荐		2
极低级证据	反对使用某项干预措施的强推荐	评价者确信干预措施弊大于利	1