Rekha Banu, Swaminathan Soumya
Tuberculosis Research Centre, Chetput, Mayor V.R. Ramanathan Road, Chennai, India.
Paediatr Respir Rev. 2007 Jun;8(2):99-106. doi: 10.1016/j.prrv.2007.04.010. Epub 2007 Jun 4.
The burden of tuberculosis (TB), worldwide, is influenced by the human immunodeficiency virus (HIV) epidemic. Between 1990 and 2004, the tuberculosis incidence stabilised or fell steadily in most parts of the world, with the exception of Africa. HIV and HIV-associated TB affects young adults, which may result in increased rates of TB transmission to children. Moreover, HIV-infected children are at increased risk of TB and of more severe forms of TB compared with immunocompetent children. There is evidence that TB is more common in children living in households affected by HIV. Owing to the higher mortality during and after TB treatment, the outcome of TB is also worse among HIV-infected children, with lower cure and higher recurrence rates. Although available reports still show low levels of drug resistance among children, continued surveillance will be important to detect any increase in resistance rates, including multidrug-resistant TB. As BCG is still the only vaccine available, research needs to be focused on better methods of preventing TB. Furthermore, the development of better diagnostics for infection and disease will improve the management of TB in children.
全球范围内，结核病负担受到人类免疫缺陷病毒（HIV）流行情况的影响。1990年至2004年间，世界上大部分地区的结核病发病率趋于稳定或稳步下降，但非洲除外。HIV及与HIV相关的结核病影响着青壮年，这可能导致结核病向儿童传播的比率上升。此外，与免疫功能正常的儿童相比，感染HIV的儿童患结核病及患更严重形式结核病的风险更高。有证据表明，在受HIV影响的家庭中生活的儿童患结核病更为常见。由于结核病治疗期间及治疗后的死亡率较高，感染HIV的儿童结核病的治疗结果也更差，治愈率较低且复发率较高。尽管现有报告显示儿童中的耐药水平仍然较低，但持续监测对于发现包括耐多药结核病在内的耐药率的任何上升都很重要。由于卡介苗仍然是唯一可用的疫苗，研究需要集中在预防结核病的更好方法上。此外，开发更好的感染和疾病诊断方法将改善儿童结核病的管理。
