Cohen Ted, Lipsitch Marc, Walensky Rochelle P, Murray Megan
Division of Social Medicine and Health Inequalities, Brigham and Women's Hospital, One Brigham Circle, 1620 Tremont Street, Boston, MA 02120, USA.
Proc Natl Acad Sci U S A. 2006 May 2;103(18):7042-7. doi: 10.1073/pnas.0600349103. Epub 2006 Apr 21.
In sub-Saharan Africa, where the emergence of HIV has caused dramatic increases in tuberculosis (TB) case notifications, new strategies for TB control are necessary. Isoniazid preventive therapy (IPT) for HIV-TB coinfected individuals reduces the reactivation of latent Mycobacterium tuberculosis infections and is being evaluated as a potential community-wide strategy for improving TB control. We developed a mathematical model of TB/HIV coepidemics to examine the impact of community-wide implementation of IPT for TB-HIV coinfected individuals on the dynamics of drug-sensitive and -resistant TB epidemics. We found that community-wide IPT will reduce the incidence of TB in the short-term but may also speed the emergence of drug-resistant TB. We conclude that community-wide IPT in areas of emerging HIV and drug-resistant TB should be coupled with diagnostic and treatment policies designed to identify and effectively treat the increasing proportion of patients with drug-resistant TB.
在撒哈拉以南非洲地区，艾滋病病毒的出现导致结核病病例通报数急剧增加，因此需要新的结核病控制策略。对同时感染艾滋病毒和结核病的个体进行异烟肼预防性治疗（IPT）可减少潜伏性结核分枝杆菌感染的复发，目前正在作为一项潜在的全社区范围策略进行评估，以改善结核病控制。我们建立了一个结核病/艾滋病病毒合并流行的数学模型，以研究在全社区范围内对同时感染艾滋病毒和结核病的个体实施IPT对药物敏感和耐药结核病流行动态的影响。我们发现，全社区范围的IPT在短期内会降低结核病发病率，但也可能加速耐药结核病的出现。我们得出结论，在出现艾滋病毒和耐药结核病的地区，全社区范围的IPT应与旨在识别并有效治疗耐药结核病患者比例不断增加的诊断和治疗政策相结合。
