Méndez-Samperio P
Departamento de Inmunología, Escuela Nacional de Ciencias Biológicas, IPN, México, México.
Scand J Immunol. 2017 Aug;86(2):76-82. doi: 10.1111/sji.12567.
Tuberculosis (TB) remains one of the most important causes of death among people co-infected with human immunodeficiency virus (HIV). The diagnosis of TB remains challenging in HIV co-infected individuals, due to a high frequency of smear-negative disease and high rates of extrapulmonary TB. Accurate, ease of use and rapid diagnosis of active TB are critical to the World Health Organization (WHO) End TB Strategy by 2050. Traditional laboratory techniques do not provide rapid and accurate results to effectively manage HIV co-infected patients. Over the last decade, molecular methods have provided significant steps in the fight against TB. However, many HIV co-infected patients do not have access to these molecular diagnostic tests. Given the costs closely related with confirming a TB diagnosis in HIV patients, an overtreatment for TB is used in this patient population. Nowadays, an estimated US $8 billion a year is required to provide TB treatment, which is very high compared with making an important strategy to improve the current diagnostic tests. This review focuses on current advances in diagnosing active TB with an emphasis on the diagnosis of HIV-associated TB. Also discussed are the main challenges that need to be overcome for improving an adequate initial diagnosis of active TB in HIV-positive patients.
结核病（TB）仍然是人类免疫缺陷病毒（HIV）合并感染人群中最重要的死亡原因之一。由于涂片阴性疾病的高发生率和肺外结核病的高发病率，在HIV合并感染个体中结核病的诊断仍然具有挑战性。准确、易用且快速地诊断活动性结核病对于世界卫生组织（WHO）到2050年终止结核病战略至关重要。传统实验室技术无法提供快速准确的结果以有效管理HIV合并感染患者。在过去十年中，分子方法在抗击结核病方面取得了重大进展。然而，许多HIV合并感染患者无法获得这些分子诊断检测。鉴于在HIV患者中确诊结核病的成本高昂，该患者群体中存在结核病过度治疗的情况。如今，每年估计需要80亿美元用于结核病治疗，与制定一项重要战略以改进当前诊断检测相比，这一成本非常高。本综述重点关注活动性结核病诊断的当前进展，尤其强调HIV相关结核病的诊断。还讨论了在改善HIV阳性患者活动性结核病的充分初始诊断方面需要克服的主要挑战。
