Currie Christine S M, Williams Brian G, Cheng Russell C H, Dye Christopher
Faculty of Mathematical Studies, University of Southampton, Southampton, UK.
AIDS. 2003 Nov 21;17(17):2501-8. doi: 10.1097/01.aids.0000096903.73209.ac.
To compare the benefits of tuberculosis (TB) treatment with TB and HIV prevention for the control of TB in regions with high HIV prevalence.
A compartmental difference equation model of TB and HIV has been developed and fitted to time series and other published data using Bayesian methods. The model is used to compare the effectiveness of TB chemotherapy with three strategies for prevention: highly active antiretroviral therapy (HAART), the treatment of latent TB infection (TLTI) and the reduction of HIV transmission.
Even where the prevalence of HIV infection is high, finding and curing active TB is the most effective way to minimize the number of TB cases and deaths over the next 10 years. HAART can be as effective, but only with very high levels of coverage and compliance. TLTI is comparatively ineffective over all time scales. Reducing HIV incidence is relatively ineffective in preventing TB and TB deaths over 10 years but is much more effective over 20 years.
In countries where the spread of HIV has led to a substantial increase in the incidence of TB, TB control programmes should maintain a strong emphasis on the treatment of active TB. To ensure effective control of TB in the longer term, methods of TB prevention should be carried out in addition to, but not as a substitute for, treating active cases.
比较在艾滋病毒高流行地区，结核病（TB）治疗与结核病和艾滋病毒预防措施对控制结核病的益处。
已建立结核病和艾滋病毒的房室差分方程模型，并使用贝叶斯方法将其拟合到时间序列和其他已发表的数据。该模型用于比较结核病化疗与三种预防策略的有效性：高效抗逆转录病毒疗法（HAART）、潜伏性结核感染治疗（TLTI）和减少艾滋病毒传播。
即使在艾滋病毒感染率很高的地区，发现并治愈活动性结核病也是在未来10年内将结核病病例数和死亡数降至最低的最有效方法。HAART可能同样有效，但前提是要有非常高的覆盖率和依从性。在所有时间尺度上，TLTI相对无效。在预防结核病和结核病死亡方面，降低艾滋病毒发病率在10年内相对无效，但在20年内则要有效得多。
在艾滋病毒传播导致结核病发病率大幅上升的国家，结核病控制项目应继续大力强调对活动性结核病的治疗。为确保长期有效控制结核病，应在治疗活动性病例之外开展结核病预防方法，但不能以此替代治疗活动性病例。
