TB/HIV: an orphan disease?
TB/HIV: an orphan disease?
复制标题
结核病/艾滋病毒：一种孤儿病？
DOI：
10.1164/rccm.201010-1753ed
复制
发表时间：
2011
影响因子：
24.7
通讯作者：
Metcalfe,JohnZ
中科院分区：
文献类型：
--
作者：
Brust,JamesCM;O'Donnell,MaxR;Metcalfe,JohnZ
Tuberculosis (TB) and human immunodeficiency virus (HIV) are tightly interwoven in a catastrophic, global syndemic. Worldwide, nearly 1.3 million patients with HIV develop TB each year, and 21% of the estimated 1.8 million HIV-associated deaths in 2009 were attributed to TB (1). Conversely, HIV has been responsible for a global resurgence of TB over the past two decades. It remains the single most important individuallevel risk factor for progression from latent TB infection to active disease, and has greatly complicated programmatic control of TB—especially in resource-limited settings. In southern Africa, approximately 70% of newly diagnosed TB cases are co-infected with HIV. As a result, a recurrent theme in global public health research is the need to integrate TB and HIV research and health services (1). Despite the alarming incidence and severity of TB/HIV co-infection, it remains underfunded, understudied, and underrepresented at international research conferences.This past year, at the 2010 Conference on Retroviruses and Opportunistic Infections, just 22 (2.2%) of the total 1,022 abstracts addressed TB/HIV co-infection (2). Only a single oral abstract session included TB/HIV presentations, and even this was a combined session including other opportunistic infections and metabolic complications of HIV. By contrast, 76 abstracts addressed Hepatitis C Virus—another important co-infection, but one that is responsible for a far lower global burden of disease and mortality than TB in HIV-infected individuals. This scarcity of TB/HIV research is, unfortunately, common at international Pulmonary and Infectious Diseases conferences. Only 8/1,435 (0.6%) and 37/5,500 (0.7%) posters, presentations, or symposia at the 2010 Infectious Diseases Society of America (IDSA) conference (3) and the 2010 American Thoracic Society conference (4), respectively, focused on TB/HIV co-infection. Although this may represent a low number of submissions, acceptances, or both, it is concerning, given the magnitude of the TB/HIV epidemic. While the International Union Against Tuberculosis and Lung Disease devotes a larger proportion of its annual conference program to TB/HIV co-infection, it has, to date, been primarily focused on programmatic and operational, rather than laboratory or translational, research (5). This under-representation of research on TB/HIV co-infection—reminiscent more of an orphan disease rather than one of the worst public health catastrophes of our time—may be due to the historic separation of TB and HIV research and care, underfunding of TB/HIV research, and the absence of a global market for TB drugs.
