Institute of Health and Society, Medical School, University of Newcastle upon Tyne, Newcastle upon Tyne, NE2 4HH, UK.
Global Health. 2009 Sep 14;5:9. doi: 10.1186/1744-8603-5-9.
Africa is facing a rapidly growing chronic non-communicable disease burden whilst at the same time experiencing continual high rates of infectious disease. It is well known that some infections increase the risk of certain chronic diseases and the converse. With an increasing dual burden of disease in Sub Saharan Africa the associations between diseases and our understanding of them will become of increased public health importance.
In this review we explore the relationships reported between tuberculosis and diabetes mellitus, human immunodeficiency virus, its treatment and metabolic risk. We aimed to address the important issues surrounding these associations within a Sub Saharan African setting and to describe the impact of globalization upon them.
Diabetes has been associated with a 3-fold incident risk of tuberculosis and it is hypothesised that tuberculosis may also increase the risk of developing diabetes. During co-morbid presentation of tuberculosis and diabetes both tuberculosis and diabetes outcomes are reported to worsen. Antiretroviral therapy for HIV has been associated with an increased risk of developing metabolic syndrome and HIV has been linked with an increased risk of developing both diabetes and cardiovascular disease. Globalization is clearly related to an increased risk of diabetes and cardiovascular disease. It may be exerting other negative and positive impacts upon infectious and chronic non-communicable disease associations but at present reporting upon these is sparse.
The impact of these co-morbidities in Sub Saharan Africa is likely to be large. An increasing prevalence of diabetes may hinder efforts at tuberculosis control, increasing the number of susceptible individuals in populations where tuberculosis is endemic, and making successful treatment harder. Roll out of anti-retroviral treatment coverage within Sub Saharan Africa is an essential response to the HIV epidemic however it is likely to lead to a growing number of individuals suffering adverse metabolic consequences. One of the impacts of globalization is to create environments that increase both diabetes and cardiovascular risk but further work is needed to elucidate other potential impacts. Research is also needed to develop effective approaches to reducing the frequency and health impact of the co-morbidities described here.
非洲正面临着慢性非传染性疾病负担的快速增长，同时也持续面临着高传染性疾病的发病率。众所周知，某些感染会增加某些慢性疾病的风险，反之亦然。在撒哈拉以南非洲，双重疾病负担不断增加，因此疾病之间的关联及其对疾病的理解将变得更加重要。
在本综述中，我们探讨了结核病与糖尿病、人类免疫缺陷病毒及其治疗和代谢风险之间报告的关系。我们旨在解决撒哈拉以南非洲地区这些关联的重要问题，并描述全球化对它们的影响。
糖尿病与结核病的发病风险增加了 3 倍，据推测，结核病也可能增加患糖尿病的风险。在结核病和糖尿病同时存在的情况下，结核病和糖尿病的结果都被报告为恶化。人类免疫缺陷病毒的抗逆转录病毒治疗与代谢综合征的风险增加有关，而人类免疫缺陷病毒与糖尿病和心血管疾病风险增加有关。全球化显然与糖尿病和心血管疾病风险增加有关。它可能对传染病和慢性非传染性疾病的关联产生其他负面和正面的影响，但目前对这些关联的报道很少。
这些合并症在撒哈拉以南非洲的影响可能很大。糖尿病的患病率不断增加可能会阻碍结核病控制工作，使结核病流行地区的易感人群增加，使治疗更加困难。在撒哈拉以南非洲推广抗逆转录病毒治疗覆盖范围是对艾滋病毒流行的必要应对措施，但这可能会导致越来越多的人遭受不良代谢后果。全球化的影响之一是创造增加糖尿病和心血管风险的环境，但还需要进一步的工作来阐明其他潜在影响。还需要研究开发有效方法来减少这里描述的合并症的发生频率和对健康的影响。
