TB Screening Among People Living With HIV/AIDS in Resource-Limited Settings
TB Screening Among People Living With HIV/AIDS in Resource-Limited Settings
复制标题
DOI：
10.1097/qai.0000000000000485
复制
发表时间：
2015-04-15
影响因子：
3.6
通讯作者：
Modi, Surbhi
中科院分区：
文献类型：
--
作者：
Date, Anand;Modi, Surbhi
结核病(TB)仍然是艾滋病毒携带者(PLHIV)发病和死亡的主要原因，这使得改进艾滋病毒相关结核病的预防和治疗对确保PLHIV的长期生存至关重要。在艾滋病毒感染者中进行结核病筛查是实施世界卫生组织旨在减少结核病和艾滋病毒综合征影响的3I干预措施的核心。有效的结核病筛查将导致确定PLHIV与推定的结核病疾病(即那些症状筛查呈阳性但需要进行适当评估的人，包括使用Xpert MTB/RIF试验等诊断工具)和那些有资格接受异烟肼预防治疗的人(即临床症状筛查阴性或筛查阳性但被发现没有结核病疾病的人)。确认患有推定结核病的PLHIV还有助于实施结核病感染控制的基本管理措施，包括快速追踪咳嗽患者，并将其与不咳嗽的PLHIV分开，以减少结核病传播。由于有助于艾滋病毒感染者中结核病的早期诊断，结核病筛查也是促进确诊为结核病的艾滋病毒感染者及早开始抗逆转录病毒治疗的关键，否则这些人可能没有资格根据CD4计数或临床分期接受抗逆转录病毒治疗。因此，结核病筛查是多种结核病/艾滋病毒干预措施的门户，也是每次就诊时艾滋病毒感染者常规临床服务的组成部分。
Tuberculosis (TB) continues to be the leading cause of morbidity and mortality among people living with HIV (PLHIV), making improved prevention and treatment of HIV-associated TB critical to ensuring long-term survival of PLHIV. TB screening among PLHIV is central to implementation of the World Health Organization's 3 I's interventions for reducing the impact of the TB and HIV syndemics. Effective TB screening will result in the identification of PLHIV with presumptive TB disease (ie, those with a positive symptom screen who require appropriate evaluation, including the use of diagnostic tools such as the Xpert MTB/RIF assay) and those eligible for isoniazid preventive therapy (ie, those who have a negative clinical symptom screen or who have a positive screen but are found not to have TB disease). Identification of PLHIV with presumptive TB also facilitates implementation of basic administrative measures for TB infection control, including fast tracking of coughing patients and separation from noncoughing PLHIV to reduce TB transmission. By contributing to the early diagnosis of TB disease among PLHIV, TB screening is also critical to facilitate early initiation of antiretroviral treatment among PLHIV diagnosed with TB disease who might not otherwise be eligible for antiretroviral treatment based on CD4 count or clinical staging. TB screening thus serves as a gateway for multiple TB/HIV interventions and is an integral part of routine clinical services for PLHIV at each clinic visit.