Narain Jai P, Lo Ying-Ru
Department of Communicable Diseases, WHO Regional Office for South-East Asia, New Delhi 110-002, India.
Indian J Med Res. 2004 Oct;120(4):277-89.
Tuberculosis (TB) has, for centuries, continued to remain a public health problem of enormous importance, particularly in the developing world, taking a heavy toll of those at their prime of life. The emergence of human immunodeficiency virus (HIV infection) and its close association with TB poses an even greater challenge to the health systems in general and TB programmes in particular, in African and Asian countries. HIV is considered to be the most potent risk factor for progression to active TB among those infected both with TB and HIV; as a result, TB is the most common life threatening opportunistic infection associated with HIV, and biggest cause of death among patients with acquired immunodeficiency syndrome (AIDS). In areas hard-hit by HIV, TB is increasing, leading to greater case load, thereby overstretching the already fragile health infrastructure. The deadly relationship between HIV and TB, each potentiating the effect of the other, requires a clearly defined strategy taking into consideration the natural history of the co-infection and its progression to clinical TB (and AIDS). It is clear that the only way to fight this is by bringing the two programmes to join forces and work creatively and innovatively. The strategy should include not only preventing HIV through community-based behavioural interventions and limiting progression to clinical TB through the use of isoniazid preventive therapy, but also early diagnosis and treatment of HIV-associated TB and AIDS using DOTS strategy and combination antiretroviral therapy respectively. The strategy probably would not succeed unless both the programmes are first strengthened before attempting to forge collaboration based on mutual strengths and comparative advantages. In addition, mobilizing national and international response, building partnerships and mobilizing resources will help a great deal in mounting an appropriate and effective response to HIV/TB in the Asian context.
几个世纪以来，结核病一直是一个极为重要的公共卫生问题，尤其是在发展中世界，给青壮年人群带来了沉重的负担。人类免疫缺陷病毒（HIV感染）的出现及其与结核病的密切关联，对整个卫生系统，尤其是非洲和亚洲国家的结核病防治项目，构成了更大的挑战。HIV被认为是感染结核病和HIV的人群发展为活动性结核病的最有力风险因素；因此，结核病是与HIV相关的最常见的危及生命的机会性感染，也是获得性免疫缺陷综合征（AIDS）患者死亡的最大原因。在受HIV严重影响的地区，结核病发病率正在上升，导致病例数增加，从而使本已脆弱的卫生基础设施不堪重负。HIV与结核病之间致命的关系，二者相互加剧对方的影响，需要一个明确界定的战略，要考虑到合并感染的自然史及其发展为临床结核病（和AIDS）的过程。显然，应对这一问题的唯一办法是让这两个项目携手合作，创造性地、创新性地开展工作。该战略不仅应包括通过基于社区的行为干预措施预防HIV，并通过使用异烟肼预防性治疗来限制发展为临床结核病，还应包括分别使用直接观察短程治疗策略和联合抗逆转录病毒疗法对HIV相关结核病和AIDS进行早期诊断和治疗。除非在尝试基于双方优势和比较优势建立合作之前先加强这两个项目，否则该战略可能不会成功。此外，调动国家和国际应对力量、建立伙伴关系以及筹集资源，将极大地有助于在亚洲背景下对HIV/结核病做出适当和有效的应对。
