MMWR Morb Mortal Wkly Rep. 2010 Nov 26;59(46):1514-7.
In resource-limited settings, high case-fatality rates are seen among tuberculosis (TB) patients with human immunodeficiency virus (HIV) infection, especially during the early months of TB treatment. HIV prevalence among TB patients has been estimated to be as high as 80%--90% in some areas of sub-Saharan Africa. In 2004, the World Health Organization (WHO) recommended increasing collaboration between HIV and TB programs. Since then, many countries, including Kenya, have worked to increase TB/HIV collaborative activities. In 2005, the Kenya Division of Leprosy, Tuberculosis, and Lung Disease (DLTLD) added questions regarding HIV testing and treatment to the existing TB surveillance system.* This report summarizes HIV data collected from Kenya's extended TB surveillance system during 2006--2009. During this period, HIV testing among TB patients increased from 60% in 2006 to 88% in 2009, and the prevalence of HIV infection among TB patients tested decreased from 52% to 44%. In 2009, 92% of HIV-infected TB patients received cotrimoxazole prophylaxis for the prevention of opportunistic infections. Although these data highlight the increase in HIV services provided to TB patients, only 34% of HIV-infected TB patients started antiretroviral therapy (ART) while being treated for TB. Innovative interventions are needed to increase HIV treatment among TB patients in Kenya, especially considering the 2009 WHO guidelines recommending that all HIV-infected TB patients be started on ART as soon as possible, regardless of CD4 count. Although these guidelines have not yet been implemented in Kenya, officials are working to identify methods of increasing access to ART for TB patients.
在资源有限的情况下,艾滋病毒(HIV)感染的肺结核(TB)患者死亡率较高,尤其是在结核病治疗的早期。在撒哈拉以南非洲的一些地区,TB 患者中的 HIV 流行率估计高达 80%-90%。2004 年,世界卫生组织(WHO)建议增加 HIV 和结核病方案之间的协作。从那时起,包括肯尼亚在内的许多国家都努力增加结核病/艾滋病毒合作活动。2005 年,肯尼亚麻风、结核病和肺部疾病司(DLTLD)在现有的结核病监测系统中增加了关于 HIV 检测和治疗的问题。本报告总结了 2006-2009 年期间从肯尼亚扩大的结核病监测系统收集的 HIV 数据。在此期间,TB 患者中的 HIV 检测率从 2006 年的 60%增加到 2009 年的 88%,接受检测的 TB 患者中 HIV 感染的流行率从 52%下降到 44%。2009 年,92%的 HIV 感染的 TB 患者接受了复方新诺明预防机会性感染。虽然这些数据突出了向 TB 患者提供的 HIV 服务的增加,但只有 34%的 HIV 感染的 TB 患者在接受结核病治疗时开始接受抗逆转录病毒治疗(ART)。肯尼亚需要创新的干预措施来增加 HIV 治疗,尤其是考虑到 2009 年世卫组织的指南建议,所有 HIV 感染的 TB 患者应尽快开始接受 ART,无论 CD4 计数如何。尽管这些指南尚未在肯尼亚实施,但官员们正在努力寻找增加 TB 患者获得 ART 的方法。