A study of the effects of ART on rates and transmission of tuberculosis

在撒哈拉以南地区，结核分枝杆菌是导致致命机会性疾病的最常见病原体 非洲。这项提案旨在展示抗逆转录病毒疗法对结核病的好处。 马西福梅莱莱。因为感染HIV-1的成人和儿童发病和死亡的主要原因是结核病， 保护家庭免受疾病侵袭是公共卫生的优先事项 非洲国家的结核病(TB)和其他呼吸道疾病正在迅速增加， 这可归因于艾滋病毒-1的爆炸性流行，结核病控制计划无效，以及在 感染的准确诊断和处理)。HIV-1以两种方式助长了结核病的流行：1)HIV-1是 潜在结核病感染重新激活为活动性疾病的最大风险因素，以及2)艾滋病毒-1感染者 新感染或再次感染结核分枝杆菌的人进展得更快 结核病。 这项研究至关重要，因为： 南非是感染艾滋病毒的5个国家之一；每100,000人中有300例) 南非每天新增1600例艾滋病毒感染者，其中360万人已经感染。 包括DOTS在内的结核病控制计划一直未能控制突发的活动性结核病。 艾滋病毒阴性者中结核病的增加与艾滋病毒的增加有关(2)。 结核病会消耗资源，并将资源从未感染艾滋病毒的人群中转移出来。 如果我们证明了抗逆转录病毒疗法对结核病发病率的影响，那么引入抗逆转录病毒疗法可能更可行。 我们的团队是唯一有资格进行这项研究的人，因为： Linda-Gaii Bekker博士在临床、流行病学和基础科学研究方面有着长期的记录， 肺结核。(3.4) 我们有一个基于世卫组织指南的完善的结核病计划，包括DOTS，在初级阶段进行管理 卫生保健级别，有结核病参考实验室和诊断实验室资源)。 我们的Masiphumelele站点有一个有效的通知和监控系统 我们已经与结核病和艾滋病毒研究人员建立了国际研究联系： 吉拉·卡普兰教授(洛克菲勒大学) Barry Kreiswirth教授(纽约公共卫生研究实验室，将提供培训和 该项目需要支持将RFLP技术转移到开普敦。 约翰·麦金尼(洛克菲勒大学) 艾伦·阿德雷姆教授(西雅图系统生物学研究所) 迈克尔·托维教授(巴黎巴斯德研究所)

Mycobacterium tuberculosis is the commonest pathogen leading to fatal opportunistic disease in sub-Saharan Africa. This proposal aims at demonstrating the benefits of antiretroviral therapy on TB in the community of Masiphumelele. Because the major cause of morbidity and mortality in HIV-1 infected adults and children is TB, safeguarding the household from the disease is a public health priority Countries in Africa are experiencing rapid increases in tuberculosis (TB), and other respiratory diseases, which is attributable to an explosive HIV-1 epidemic, ineffective TB control programs and difficulties in the accurate diagnosis and management of infections o). HIV-1 fuels the TB epidemic in two ways: 1) HIV-1 is the most powerful risk factor for reactivation of latent TB infection to active disease, and 2) HIV-1 infected persons who become newly infected or re-infected with Mycobacterium tuberculosis progress much more rapidly to active TB. This study is of crucial importance because: South Africa is one of 5 countries with HIV-positive TB > 300 cases/100,0000) There are 1600 new HIV infections daily in South Africa, 3.6 million already infected. TB control programs including DOTS have not been able to contain incident active TB. The increase of TB in HIV negative individuals relates to the increasing HIV (2). Tuberculosis consumes resources and shifts them from the HIV uninfected population. Introduction of ART may be more feasible if we demonstrate an impact of ART on TB incidence. Our group is uniquely qualified to conduct this research because: Dr Linda-Gaii Bekker has a long standing record of clinical, epidemiological and basic science research, of tuberculosis. (3.4) We have a well established TB program based on the WHO guidelines including DOTS, managed at a primary health care level, with tuberculosis reference labs, and diagnostic laboratory resources ¿). Our Masiphumelele site has an effective notification and surveillance system We have established international research links with TB and HIV researchers: Prof. Gilla Kaplan, (Rockefeller university), Prof. Barry Kreiswirth( Public Health Research Laboratory, NY, who will provide the training and support required by this project to transfer the RFLP technology to Cape Town. John McKinney (Rockefeller University) Prof. Alan Aderem (Institute of Systems Biology, Seattle) Prof. Michael Tovey (Pasteur Institute, Paris)