Centre for the AIDS Programme of Research in South Africa, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
Division of Pulmonology and Critical Care, Department of Internal Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
BMC Public Health. 2018 Mar 27;18(1):417. doi: 10.1186/s12889-018-5362-4.
The global predominance of tuberculosis in men has received significant attention. However, epidemiological studies now demonstrate that there is an increased representation of young women with tuberculosis, especially in high HIV burden settings where young women bear a disproportionate burden of HIV. The role of the HIV epidemic, as well as changes in behavioural, biological, and structural risk factors are explored as potential explanations for the increasing burden of tuberculosis in young women.
As young women are particularly vulnerable to HIV infection in sub-Saharan Africa, it is unsurprising that the TB epidemic in this setting has become increasingly feminised. This age-sex trend of TB in South Africa is similar to WHO estimates for other countries with a high HIV prevalence where there are more female than male cases notified up to the age of 25 years. The high prevalence of anaemia of chronic disease in young women with HIV is an additional potential reason for their increased TB risk. The widespread use of injectable medroxyprogesterone acetate contraception, which has been shown to possess selective glucocorticoid effect and oestrogen suppression, in young women may be an important emerging biological risk factor for tuberculosis in young women. Behavioural factors such as alcohol use and tobacco smoking patterns are further factors which may be responsible for the narrowing of the sex gap in TB epidemiology. In comparison to the significantly higher alcohol consumption rates in men globally, there is a narrowing gap in alcohol consumption between the sexes in South Africa with alarming rates of alcohol abuse in young women. There is a similar narrowing of the tobacco smoking gap between the sexes in South Africa, with increasing smoking prevalence in young women.
With nearly 70% of all TB patients being co-infected with HIV in our setting, it is not surprising that the age and sex distribution of TB is increasingly resembling the distribution of HIV in this region of dual hyperendemicity. New TB service design must begin to reflect the presence of young women as a significant group burdened by the disease.
结核病在男性中的全球流行已受到广泛关注。然而，流行病学研究现在表明，结核病患者中年轻女性的比例有所增加，尤其是在艾滋病毒负担较高的地区，年轻女性承受着不成比例的艾滋病毒负担。艾滋病毒流行以及行为、生物和结构危险因素的变化被认为是结核病在年轻女性中负担增加的潜在原因。
由于年轻女性在撒哈拉以南非洲特别容易感染艾滋病毒，因此该地区的结核病流行呈女性化趋势也就不足为奇了。南非这种年龄-性别结核病趋势与世界卫生组织对其他艾滋病毒流行率高的国家的估计相似，在这些国家，25 岁以下报告的病例中女性多于男性。年轻的 HIV 感染者中慢性疾病性贫血的高患病率是导致其结核病风险增加的另一个潜在原因。广泛使用的醋酸甲羟孕酮注射避孕法被认为是年轻女性结核病的一个重要新兴生物学危险因素，因为它具有选择性糖皮质激素作用和雌激素抑制作用。行为因素，如饮酒和吸烟模式，也是导致结核病流行病学中性别差距缩小的因素。与全球男性饮酒率显著较高相比，南非男女之间的饮酒差距正在缩小，年轻女性酗酒的惊人比例令人担忧。南非男女之间的吸烟差距也在缩小，年轻女性的吸烟率呈上升趋势。
在我们的研究环境中，近 70%的结核病患者同时感染了 HIV，因此结核病的年龄和性别分布越来越类似于该地区双重流行的 HIV 分布也就不足为奇了。新的结核病服务设计必须开始反映出年轻女性作为一个重要群体，她们深受这种疾病的困扰。
