Opportunities and challenges for HIV care in overlapping HIV and TB epidemics
Opportunities and challenges for HIV care in overlapping HIV and TB epidemics
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DOI：
10.1001/jama.300.4.423
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发表时间：
2008-07-23
影响因子：
120.7
通讯作者：
Nunn, Paul
中科院分区：
文献类型：
--
作者：
Havlir, Diane V.;Getahun, Haileyesus;Nunn, Paul
结核病（TB）和新出现的耐多药结核病流行是资源有限环境下人类免疫缺陷病毒（HIV）护理和治疗规划面临的主要挑战。结核病是艾滋病毒感染者死亡的一个主要原因，在整个艾滋病毒病程中，甚至在成功开始抗逆转录病毒治疗之后，都存在风险。旨在减少艾滋病毒感染者结核病负担的活动的实施进展远远落后于全球目标。为纵向护理而设计的艾滋病毒规划非常适合实施结核病控制措施，除了大力解决结核病问题，以挽救患者生命，保障在艾滋病毒治疗方面的巨额投资，并遏制全球结核病负担外，别无选择。我们提出了艾滋病毒护理计划的战略行动框架，以最佳方式将结核病纳入其服务。该框架的核心活动包括加强结核病病例发现、结核病治疗、异烟肼预防性治疗、感染控制、抗逆转录病毒药物治疗管理、结核病记录和报告，以及国家和地方各级艾滋病毒和结核病规划的共同努力。
Tuberculosis (TB) and the emerging multidrug-resistant TB epidemic represent major challenges to human immunodeficiency virus (HIV) care and treatment programs in resource-limited settings. Tuberculosis is a major cause of mortality among patients with HIV and poses a risk throughout the course of HIV disease, even after successful initiation of antiretroviral therapy (ART). Progress in the implementation of activities directed at reducing TB burden in the HIV population lags far behind global targets. HIV programs designed for longitudinal care are ideally suited to implement TB control measures and have no option but to address TB vigorously to save patient lives, to safeguard the massive investment in HIV treatment, and to curb the global TB burden. We propose a framework of strategic actions for HIV care programs to optimally integrate TB into their services. The core activities of this framework include intensified TB case finding, treatment of TB, isoniazid preventive treatment, infection control, administration of ART, TB recording and reporting, and joint efforts of HIV and TB programs at the national and local levels.