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

结核分枝杆菌是导致撒哈拉以南非洲致命性机会性疾病的最常见病原体 非洲该提案旨在证明抗逆转录病毒疗法对结核病在以下社区的益处： Masiphumelele。由于感染HIV-1的成人和儿童发病和死亡的主要原因是结核病， 保护家庭免受疾病的侵害是公共卫生的优先事项 非洲国家的结核病和其他呼吸道疾病正在迅速增加， 这是由于HIV-1的爆发性流行，无效的结核病控制计划以及 感染的准确诊断和管理。HIV-1以两种方式助长结核病流行：1）HIV-1是结核病的主要病原体， 潜伏性结核感染再激活为活动性疾病的最强有力的危险因素，以及2）HIV-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， TB. 这项研究至关重要，因为： 南非是艾滋病毒阳性结核病病例数超过300例/10万人的5个国家之一） 南非每天有1600名新的艾滋病毒感染者，360万人已经感染。 包括直接督导下的短程化疗在内的结核病控制方案未能控制活动性结核病的发生。 HIV阴性个体中结核病的增加与HIV的增加有关（2）。 结核病消耗资源，并将其从未感染艾滋病毒的人口转移。 如果我们证明抗逆转录病毒疗法对结核病发病率的影响，那么引进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，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悠久的历史， 结核（第3.4节） 我们有一个完善的结核病规划，其基础是世卫组织的指导方针，包括直接督导下的短程化疗， 卫生保健水平，结核病参考实验室和诊断实验室资源）。 我们的Masiphumelele网站有一个有效的通知和监督系统 我们与结核病和艾滋病研究人员建立了国际研究联系： 教授Gilla Kaplan（洛克菲勒大学）， 教授巴里Kreisperth（公共卫生研究实验室，纽约，谁将提供培训， 本项目所需的支持，将RFLP技术转移到开普敦。 约翰·麦金尼（洛克菲勒大学） 教授Alan Aderem（系统生物学研究所，西雅图） 教授Michael Tovey（巴斯德研究所，巴黎）

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)