Beneficial and perverse effects of isoniazid preventive therapy for latent tuberculosis infection in HIV-tuberculosis coinfected populations
Beneficial and perverse effects of isoniazid preventive therapy for latent tuberculosis infection in HIV-tuberculosis coinfected populations
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DOI：
10.1073/pnas.0600349103
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发表时间：
2006-05-02
影响因子：
11.1
通讯作者：
Murray, M
中科院分区：
文献类型：
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作者：
Cohen, T;Lipsitch, M;Murray, M
在撒哈拉以南非洲，艾滋病毒的出现导致结核病（TB）病例报告急剧增加，因此有必要制定新的结核病控制战略。异烟肼预防性治疗（IPT）的艾滋病毒-结核病合并感染的个人减少潜伏性结核分枝杆菌感染的再激活，并正在评估作为一个潜在的社区范围内的战略，以改善结核病控制。我们开发了一个结核病/艾滋病共流行的数学模型，以研究在社区范围内对结核病和艾滋病共感染者实施IPT对药物敏感和耐药结核病流行动态的影响。我们发现，社区范围的IPT将在短期内降低结核病的发病率，但也可能加速耐药结核病的出现。我们的结论是，在新出现的艾滋病毒和耐药结核病地区的社区范围内的IPT应该与诊断和治疗政策相结合，旨在识别和有效治疗越来越多的耐药结核病患者的比例。
In sub-Saharan Africa, where the emergence of HIV has caused dramatic increases in tuberculosis (TB) case notifications, new strategies for TB control are necessary. Isoniazid preventive therapy (IPT) for HIV-TB coinfected individuals reduces the reactivation of latent Mycobacterium tuberculosis infections and is being evaluated as a potential community-wide strategy for improving TB control. We developed a mathematical model of TB/HIV coepidemics to examine the impact of community-wide implementation of IPT for TB-HIV coinfected individuals on the dynamics of drug-sensitive and -resistant TB epidemics. We found that community-wide IPT will reduce the incidence of TB in the short-term but may also speed the emergence of drug-resistant TB. We conclude that community-wide IPT in areas of emerging HIV and drug-resistant TB should be coupled with diagnostic and treatment policies designed to identify and effectively treat the increasing proportion of patients with drug-resistant TB.