Grant A D, De Cock K M
London School of Hygiene and Tropical Medicine, London, UK.
Br Med Bull. 1998;54(2):369-81. doi: 10.1093/oxfordjournals.bmb.a011694.
The burden of HIV infection and disease continues to increase in many developing countries. An emerging theme is of an HIV pandemic composed of mini-epidemics, each with its own characteristics in terms of the trends in HIV prevalence, those affected, and the HIV-related opportunistic diseases observed. A number of explanations for the observed differences in the spread of HIV infection have been proposed but since the factors concerned, such as sexual behaviour and the prevalence of other sexually transmitted diseases, are closely interrelated, it is difficult to tease out which are the most important. Among HIV-related opportunistic diseases, tuberculosis stands out as the most important cause of morbidity and mortality in most developing countries, but the relative prevalence of other diseases shows considerable regional variation. Thus, there is a need for local approaches to the global problem of managing HIV disease. The most pressing public health challenges are to use existing knowledge of strategies to reduce HIV transmission, and to apply them in ways appropriate to the local situation, and to develop, evaluate and implement interventions to prolong healthy life in those already infected.
在许多发展中国家，艾滋病毒感染及疾病负担持续加重。一个新出现的主题是，艾滋病毒大流行由小规模流行构成，每一次小规模流行在艾滋病毒流行趋势、受影响人群以及所观察到的与艾滋病毒相关的机会性疾病方面都有其自身特点。针对所观察到的艾滋病毒感染传播差异，已提出多种解释，但由于性行为和其他性传播疾病的流行率等相关因素密切相关，很难梳理出哪些是最重要的因素。在与艾滋病毒相关的机会性疾病中，结核病在大多数发展中国家是发病和死亡的最重要原因，但其他疾病的相对流行率存在显著的地区差异。因此，需要针对全球艾滋病毒疾病管理问题采取因地制宜的方法。最紧迫的公共卫生挑战是利用现有关于减少艾滋病毒传播策略的知识，并以适合当地情况的方式加以应用，以及制定、评估和实施干预措施，以延长已感染者的健康寿命。
