Tuberculosis 3 The HIV-associated tuberculosis epidemic-when will we act?
Tuberculosis 3 The HIV-associated tuberculosis epidemic-when will we act?
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DOI：
10.1016/s0140-6736(10)60409-6
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发表时间：
2010-05-01
期刊：
影响因子：
168.9
通讯作者：
De Cock, Kevin M.
中科院分区：
文献类型：
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作者：
Harries, Anthony D.;Zachariah, Rony;De Cock, Kevin M.
尽管有政策、战略和指导方针，艾滋病毒相关结核病的流行仍在肆虐，特别是在南部非洲。我们把注意力集中在疾病负担最重的区域，特别是撒哈拉以南非洲，并集中力量预防艾滋病毒感染者的结核病，这是一项被严重忽视的挑战。我们主张采取更积极的方法，在受影响的社区早期诊断和治疗艾滋病毒感染，并建议对频繁的艾滋病毒检测和早期开始抗逆转录病毒治疗（ART）进行紧急评估。这一方法应通过个人免疫重建和减少艾滋病毒传播，在短期和长期内降低结核病发病率。实施3Is政策（加强结核病病例发现、感染控制和异烟肼预防性治疗），以预防艾滋病毒相关结核病，加上及早开始抗逆转录病毒治疗，将减轻艾滋病毒感染者的结核病负担，并为抗逆转录病毒治疗提供安全的临床环境。但很少有人接受复方新诺明预防和抗逆转录病毒治疗，我们就如何改善这种情况提出了切实可行的建议。艾滋病毒的早期诊断和治疗、3Is和艾滋病毒综合护理一揽子计划，加上结核病的短期直接观察治疗，构成了预防和控制艾滋病毒相关结核病的基础。这一行动呼吁建议，艾滋病毒和结核病方案都应执行已知有效的战略，并测试可能奏效的创新战略。与艾滋病毒有关的结核病继续流行，需要采取大胆但负责任的行动，否则，未来将只是过去的翻版。
Despite policies, strategies, and guidelines, the epidemic of HIV-associated tuberculosis continues to rage, particularly in southern Africa. We focus our attention on the regions with the greatest burden of disease, especially sub-Saharan Africa, and concentrate on prevention of tuberculosis in people with HIV infection, a challenge that has been greatly neglected. We argue for a much more aggressive approach to early diagnosis and treatment of HIV infection in affected communities, and propose urgent assessment of frequent testing for HIV and early start of antiretroviral treatment (ART). This approach should result in short-term and long-term declines in tuberculosis incidence through individual immune reconstitution and reduced HIV transmission. Implementation of the 3Is policy (intensified tuberculosis case finding, infection control, and isoniazid preventive therapy) for prevention of HIV-associated tuberculosis, combined with earlier start of ART, will reduce the burden of tuberculosis in people with HIV infection and provide a safe clinical environment for delivery of ART. Some progress is being made in provision of HIV care to HIV-infected patients with tuberculosis, but too few receive co-trimoxazole prophylaxis and ART We make practical recommendations about how to improve this situation. Early HIV diagnosis and treatment, the 3Is, and a comprehensive package of HIV care, in association with directly observed therapy, short-course (DOTS) for tuberculosis, form the basis of prevention and control of HIV-associated tuberculosis. This call to action recommends that both HIV and tuberculosis programmes exhort implementation of strategies that are known to be effective, and test innovative strategies that could work. The continuing HIV-associated tuberculosis epidemic needs bold but responsible action, without which the future will simply mirror the past.