Challenges and opportunities to prevent tuberculosis in people living with HIV in low-income countries
| Autor: | Anthony D. Harries, L N Patel, J P K Nyengele, Nadia Aït-Khaled, C-Y Chiang, J. Tonsing, I Syed, Srinath Satyanarayana, J-P Dongo, I. Monedero-Recuero, I. D. Rusen, V Zamora, A S Thu, Yan Lin, R Nyinoburyo, Thet Ko Aung, V Schwoebel, J. Caminero Luna, Riitta A Dlodlo, T Sanda, Arnaud Trébucq, Alberto Piubello, Francesca Conradie, Sarabjit Chadha, Nay Lynn Oo, Ajay M. V. Kumar, C. Zishiri, R. T. Ncube, E Heldal, P. I. Fujiwara, Sven Gudmund Hinderaker, Stephen M. Graham, K G Koura, A Nakanwagi-Mukwaya, Alberto Roggi, N. Mlilo, Paul M. Jensen |
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| Rok vydání: | 2019 |
| Předmět: |
Pulmonary and Respiratory Medicine
Tuberculosis Anti-HIV Agents Human immunodeficiency virus (HIV) Antitubercular Agents Developing country HIV Infections medicine.disease_cause 03 medical and health sciences 0302 clinical medicine Intervention (counseling) Environmental health Isoniazid Medicine Humans 030212 general & internal medicine Developing Countries Poverty Screening procedures Immunodeficiency Cause of death business.industry medicine.disease CD4 Lymphocyte Count Infectious Diseases 030228 respiratory system business |
| Zdroj: | The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease. 23(2) |
| ISSN: | 1815-7920 |
| Popis: | People living with the human immunodeficiency virus (HIV) (PLHIV) are at high risk for tuberculosis (TB), and TB is a major cause of death in PLHIV. Preventing TB in PLHIV is therefore a key priority. Early initiation of antiretroviral therapy (ART) in asymptomatic PLHIV has a potent TB preventive effect, with even more benefits in those with advanced immunodeficiency. Applying the most recent World Health Organization recommendations that all PLHIV initiate ART regardless of clinical stage or CD4 cell count could provide a considerable TB preventive benefit at the population level in high HIV prevalence settings. Preventive therapy can treat tuberculous infection and prevent new infections during the course of treatment. It is now established that isoniazid preventive therapy (IPT) combined with ART among PLHIV significantly reduces the risk of TB and mortality compared with ART alone, and therefore has huge potential benefits for millions of sufferers. However, despite the evidence, this intervention is not implemented in most low-income countries with high burdens of HIV-associated TB. HIV and TB programme commitment, integration of services, appropriate screening procedures for excluding active TB, reliable drug supplies, patient-centred support to ensure adherence and well-organised follow-up and monitoring that includes drug safety are needed for successful implementation of IPT, and these features would also be needed for future shorter preventive regimens. A holistic approach to TB prevention in PLHIV should also include other important preventive measures, such as the detection and treatment of active TB, particularly among contacts of PLHIV, and control measures for tuberculous infection in health facilities, the homes of index patients and congregate settings. |
| Databáze: | OpenAIRE |
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