Management of rheumatic heart disease in uganda: the emerging epidemic of non-AIDS comorbidity in resource-limited settings.
Management of rheumatic heart disease in uganda: the emerging epidemic of non-AIDS comorbidity in resource-limited settings.
复制标题
乌干达风湿性心脏病的治疗：资源有限环境中新出现的非艾滋病合并症流行病。
DOI：
10.1097/qai.0b013e3182a03eb9
复制
发表时间：
2014
期刊：
影响因子：
--
通讯作者：
Salata,RobertA
中科院分区：
文献类型：
--
作者：
Longenecker,ChrisT;Okello,Emmy;Lwabi,Peter;Costa,MarcoA;Simon,DanielI;Salata,RobertA
致编辑：在过去十年中，抗逆转录病毒疗法在资源有限环境中的推广极大地改变了撒哈拉以南非洲艾滋病流行的面貌。1艾滋病毒/艾滋病护理方面的进展在很大程度上归功于各国政府和非政府艾滋病组织成功的双边和多边合作。例如，在乌干达，在国家卫生研究所和总统艾滋病紧急救援计划的资助下，凯斯西储大学和其他机构与乌干达机构合作，建立了全面的艾滋病毒/艾滋病基础设施。由于这种协调一致的努力，该国主要城市地区的艾滋病毒流行率从25%的峰值下降到30%，现在全国为7%，近一半有资格接受治疗的人目前正在接受治疗。由于艾滋病毒现已成为一种可控制的慢性疾病，受感染的人口已经老龄化，并且越来越多地认识到心血管疾病（CVD）等合并症的发病率较高。艾滋病毒/艾滋病和非传染性疾病双重流行病的幽灵可能对这些脆弱的保健系统提出很大的要求。3除了在发达国家和发展中国家观察到缺血性心脏病的较高风险外，在RLS中感染艾滋病毒的人中，结核性心包炎和风湿性心脏病（RHD）等地方性心血管疾病的负担尚不清楚。认识到这一新的需求，Makerere大学医学院，Mulago医院和乌干达心脏研究所（UHI）与CWRU合作，将合作范围从艾滋病毒/艾滋病扩展到CVD，神经病学和肿瘤学。由美国国立卫生研究院/福格蒂国际医学教育合作伙伴计划资助的心脏病学合作项目旨在为心血管专家提供适合背景的培训，并对心血管疾病风险因素进行研究，包括艾滋病毒/艾滋病的影响。作为医学教育合作伙伴计划合作的一部分，2012年8月，来自CWRU的一个心脏病专家团队前往乌干达坎帕拉，在UHI Mulago医院新开设的心导管实验室进行手术，包括该国首例经皮二尖瓣球囊瓣膜成形术治疗风湿性二尖瓣狭窄（图2和3）。1A、B）。虽然在发达国家很少见，但风湿性心脏病仍然是RLS心血管发病率和死亡率的主要原因，仅在撒哈拉以南非洲就影响了100多万儿童。风湿性心脏病是风湿热的一种慢性并发症，风湿热是A组链球菌性咽炎引起的一种自身免疫反应，可引起不同程度的心脏炎。严重的瓣膜返流或狭窄可能发生在最初的损伤期间或急性风湿热反复发作对瓣膜造成的反复损伤之后。5充血性心力衰竭然后不知不觉地发展，如果不修复瓣膜，可能导致生命的第二至第五个十年死亡。在发达国家，目前治疗无明显返流的风湿性二尖瓣狭窄的首选方法是经皮球囊瓣膜成形术。6乌干达第一个受益于这种微创手术的病人是艾滋病毒感染者。在一个艾滋病毒/艾滋病流行率很高的国家，这名患者碰巧感染了艾滋病毒可能是一种巧合。然而，在该国，艾滋病毒对风湿性心脏病（和其他地方性非传染性疾病）的影响方面出现了一些问题。围产期感染艾滋病毒的儿童比未感染的同龄人更有可能或更少可能获得...
To the Editors: The expansion of antiretroviral therapy (ART) in resource-limited settings (RLS) has dramatically changed the face of the AIDS epidemic in sub-Saharan Africa over the past decade. 1 The progress in HIV/AIDS care is in large part due to successful bilateral and multilateral collaborations of governments and nongovernmental AIDS organizations. In Uganda, for example, with funding support from the National Institutes of Health and the President’s Emergency Plan for AIDS Relief, the Case Western Reserve University (CWRU) and others have partnered with Ugandan institutions to develop a comprehensive HIV/AIDS infrastructure. Because of this concerted effort, the country has seen a fall in HIV prevalence from a peak of 25% to 30% in major urban areas to now, 7% nationally, and nearly half of those who qualify for treatment are currently receiving it. 2 These successes, however, bring new challenges. As HIV has now become a manageable chronic disease, the infected population has aged and the higher prevalence of comorbidities such as cardiovascular disease (CVD) is increasingly recognized. The specter of a dual epidemic of HIV/AIDS and noncommunicable disease threatens to place significant demands on these fragile health-care systems. 3 In addition to the higher risk of ischemic heart disease observed in the developed and developing world, the burden of endemic CVD such as tuberculous pericarditis and rheumatic heart disease (RHD) among persons living with HIV in RLS is unknown. Recognizing this emerging need, Makerere University School of Medicine, Mulago Hospital, and the Uganda Heart Institute (UHI) have partnered with CWRU to extend collaboration beyond HIV/AIDS to CVD, neurology, and oncology. Funded in part by the National Institutes of Health/Fogarty International Medical Education Partnership Initiative, the cardiology collaboration aims to provide contextually appropriate training of cardiovascular specialists and conduct research on CVD risk factors, including the impact of HIV/AIDS. As part of the Medical Education Partnership Initiative collaboration, a team of cardiologists from CWRU traveled to Kampala, Uganda, in August 2012 to perform procedures in the newly opened cardiac catheterization laboratory at the UHI, Mulago Hospital, including the country’s first percutaneous mitral balloon valvuloplasties for rheumatic mitral stenosis (Figs. 1A, B). Although rarely seen in the developed world, RHD remains a leading cause of cardiovascular morbidity and mortality in RLS, affecting over 1 million children in sub-Saharan Africa alone. 4 RHD is a chronic complication of rheumatic fever, an autoimmune reaction to antecedent group A streptococcus pharyngitis that causes varying degrees of carditis. 5 Significant valvular regurgitation or stenosis may occur during the initial insult or after repeated damage to the valve from recurrent bouts of acute rheumatic fever. 5 Congestive heart failure then develops insidiously and may lead to death in the second to fifth decades of life if the valve is not repaired. The current treatment of choice in developed countries for rheumatic mitral valve stenosis without significant regurgitation is percutaneous balloon valvuloplasty. 6 The first patient to benefit from this minimally invasive procedure in Uganda was HIV infected. In a country with a high prevalence of HIV/AIDS, it may be a coincidence that this patient happened to be HIV infected. Nonetheless, several questions arise regarding the impact of HIV on RHD (and other endemic noncommunicable disease) in the country. Are perinatally HIV-infected children more or less likely than their uninfected peers to acquire …
登录
查看更多内容
影响因子：
3.9
作者：
du Toit, Riette;Whitelaw, David;Esser, Monika
通讯作者：
Esser, Monika
与艾滋病相关的血清阴性类风湿性关节炎。
影响因子：
27.4
作者：
A. Jaffer
通讯作者：
A. Jaffer
人类免疫缺陷病毒感染引起的急性风湿热。
影响因子：
28.2
作者：
K. Radcliffe;K. Mclean;A. Benbow
通讯作者：
A. Benbow
赞比亚的银屑病关节炎和人类免疫缺陷病毒感染。
影响因子：
3.9
作者：
P. Njobvu;P. McGill
通讯作者：
P. McGill
影响因子：
11.8
作者：
Factor SH;Levine OS;Schwartz B;Harrison LH;Farley MM;McGeer A;Schuchat A
通讯作者：
Schuchat A