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结核病与HIV的联合给公共卫生和社会经济带来直接的严重威胁,在第三世界尤其如此。1992年初,WHO估计自HIV大流行开始以来,约有400万人已受结核杆菌和HIV双重感染,其中95％在发展中国家。结核病和HIV之间的联合是显而易见的,因为在HIV受染者中,结核病的发病率估计可高达每年5—8％,结核病病人中HIV的血清阳性率很高,爱滋病病人中结核病大量出现,以及在几个非洲国家中结核病病例报告人数的增加与HIV流行的扩展相一致。 这两种流行病对于一些资源贫乏国家的冲击造成社会的和医疗的可怕后果,当前业已过度紧张的卫生机构必须面对日益严重的结核病问题。HIV感染使结核病的形势更加恶化,因为它能使受双重感染者的潜伏性结核病再度活跃的机会增加,又能使原HIV受染者新感染的结核病加速进展。这又会引起一般人口中结核病感染危险率的增加和随之而来的病例增多。为了对这一迫切问题作出反应,必须在那些结核病控制规程建立不完善而且HIV和结核病感染盛行的国家中,将加强结核病控制规程置于最优先的地位。除了通过结核病病人的早期诊断和及时治疗来提高治愈率以外,还有两项需加以考虑的主要策略,即在HIV感染的人群中施行卡介苗接种,以及预防性的化学治疗。后一项策略被认为是可能有助于在受到双重感染的人群中限制预
The combination of tuberculosis and HIV poses a direct and serious threat to public health and socio-economic, especially in the Third World. In early 1992, WHO estimated that about 4 million people have been infected with Mycobacterium tuberculosis and HIV since the start of the HIV epidemic, 95% of them in developing countries. The combination of tuberculosis and HIV is evident because the incidence of tuberculosis is estimated at up to 5-8% per year among HIV-infected individuals, high HIV seroprevalence among tuberculosis patients, and a substantial presence of tuberculosis among AIDS patients, As well as the increase in reported tuberculosis cases in several African countries in line with the expansion of the HIV epidemic. The impact of both epidemics on some resource-poor countries has terrible social and medical consequences. The current over-stretched health agencies must face an increasingly serious problem of tuberculosis. HIV infection exacerbates the problem of tuberculosis because it increases the chances of reactivation of latent tuberculosis in double-infected individuals and accelerates the rate of newly infected tuberculosis in those infected with HIV. This, in turn, will lead to an increase in the risk of tuberculosis infection in the general population and the consequent increase in cases. To respond to this pressing issue, the priority of strengthening TB control protocols must be given priority in those countries where TB control procedures are poorly established and HIV and tuberculosis are prevalent. In addition to improving the cure rate through the early diagnosis and timely treatment of TB patients, there are two key strategies to be considered: BCG vaccination in HIV-infected populations and preventative chemotherapies. The latter strategy is thought to be likely to help limit pre-treatment among people who are double-infected