WHO Collaborating Centre for TB and Lung Diseases, Fondazione S. Maugeri, Tradate, Italy.
Trop Med Int Health. 2010 Sep;15(9):1052-66. doi: 10.1111/j.1365-3156.2010.02581.x. Epub 2010 Jun 10.
Tuberculosis (TB) remains a global emergency and is responsible for 1.7 million deaths annually. Widespread global misuse of isoniazid and rifampicin over three decades has resulted in emergence of the ominous spread of multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) globally. These difficult to treat resistant forms of TB are increasingly seen in Asia, Eastern Europe, South America and sub-Saharan Africa, disrupting TB and HIV control programmes. We review the latest available global epidemiological and clinical evidence on drug-resistant TB in HIV-infected and uninfected populations, with focus on Africa where data are scanty because of poor diagnostic and reporting facilities. The difficult management and infection control problems posed by drug-resistant TB in HIV-infected patients are discussed. Given the increasing current global trends in MDR-TB, aggressive preventive and management strategies are urgently required to avoid disruption of global TB control efforts. The data suggest that existing interventions, public health systems and TB and HIV programmes must be strengthened significantly. Political and funder commitment is essential to curb the spread of drug-resistant TB.
结核病（TB）仍然是全球紧急情况，每年造成 170 万人死亡。三十多年来，异烟肼和利福平的广泛全球滥用导致多药耐药结核病（MDR-TB）和广泛耐药结核病（XDR-TB）的不祥传播在全球范围内出现。这些难以治疗的耐药结核病形式在亚洲、东欧、南美洲和撒哈拉以南非洲越来越常见，破坏了结核病和艾滋病毒控制规划。我们回顾了最新的全球流行病学和临床证据，这些证据涉及 HIV 感染者和未感染者中的耐药结核病，重点是非洲，由于诊断和报告设施差，数据稀少。讨论了耐药结核病对 HIV 感染者患者的管理和感染控制带来的困难。鉴于目前全球 MDR-TB 的趋势不断增加，迫切需要采取积极的预防和管理策略，以避免破坏全球结核病控制工作。数据表明，必须大大加强现有干预措施、公共卫生系统以及结核病和艾滋病毒方案。遏制耐药结核病的传播需要政治和资金承诺。
