Zachariah R, Massaquoi M
Medecins sans Frontieres, Operational Research HIV-TB, Medical department, Brussels Operational Center, 68 Rue de Gaspench, L-1617 Luxemburg.
Trop Doct. 2006 Apr;36(2):79-82. doi: 10.1258/004947506776593314.
Despite provisional recommendations from the World Health Organization and UNAIDS that cotrimoxazole (CTX) prophylaxis be offered to all individuals living with AIDS, including HIV-positive patients with TB, its routine use in developing countries particularly Africa has been minimal. Concerns were expressed regarding its effectiveness in areas of high bacterial resistance, that its widespread use might substantially increase bacterial cross-resistance in the community and that this intervention might promote resistance of malaria parasites to sulphadoxine-pyrimethamine. We review the current evidence on the above concerns and highlight the main operational considerations related to implementing CTX prophylaxis as a basic component of care for HIV-positive TB patients in developing countries.
尽管世界卫生组织和联合国艾滋病规划署提出了临时建议，即向所有艾滋病患者（包括合并结核病的艾滋病毒阳性患者）提供复方新诺明（CTX）预防治疗，但在发展中国家尤其是非洲，其常规使用情况却极少。人们对其在细菌耐药性高的地区的有效性表示担忧，担心其广泛使用可能会大幅增加社区中的细菌交叉耐药性，并且这种干预措施可能会促使疟原虫对磺胺多辛-乙胺嘧啶产生耐药性。我们回顾了关于上述担忧的现有证据，并强调了在发展中国家将CTX预防治疗作为艾滋病毒阳性结核病患者基本护理组成部分实施时的主要操作考量因素。
