肺结核与艾滋病结合的危险有多大
2009-09-21 18:42:45 来源: 人民网(北京)
23岁的来自安徽的杨某,最近查出得了侵润型肺结核。他现在吃了国家提供的组合用药,是政府免费提供的。他还是容易感冒,有时候低烧,而且感冒很难好。感冒时也咳嗽但无痰。跟吃药前比起来没明显好转。杨某是一个艾滋病患者,他会经常问:“我该怎么办?”
据介绍,中国的肺结核感染规模位居世界第二,在印度之后。估计中国人口的45%有潜伏性肺结核感染,目前的发病人数达到450万,占全世界的15%。中国每年因肺结核死亡的人数超过25万,并且肺结核与HIV艾滋病毒同时感染的风险越来越高。中国的艾滋病传染依然在扩大。肺结核与艾滋病结合,两种疾病会不会只是一种命运?
艾滋病的蔓延 加速了肺结核的流行
在今年7月南非开普敦召开第五届国际艾滋病大会上,世界卫生专家警告说,肺结核病已成为当前艾滋病患者死亡的主要原因,因此肺结核与艾滋病不应该再被看作两个独立问题,国际社会应该加倍努力对付它们间的交互作用。
医学资料显示,肺结核缩短了艾滋病病毒感染者的期望寿命;反过来艾滋病病毒也攻击免疫系统,从而促进结核菌的传播,并使得许多结核菌携带者最终发展成肺结核患者。在意大利、卢旺达、西班牙和美国开展的研究发现,感染了艾滋病病毒的结核菌携带者,发展为肺结核的可能性比未感染艾滋病病毒者高30到50倍。
事实上,近年来肺结核与艾滋病交互作用的趋势十分明显,目前全世界大约每3个艾滋病病毒感染者中就有1个人同时得了肺结核。世界卫生组织防治肺结核部代主任马利奥?拉维格里奥纳说,在世界卫生组织宣布全球肺结核紧急危机10年后,肺结核疫情甚至变得更严重了,主要是因为艾滋病病毒的传播。需要加倍努力对付这两种致命疾病的交互作用,它们彼此加重了对方的影响。
然而近几年来,非洲艾滋病的蔓延使肺结核的流行速度加快,大大超过了DOTS治疗的推广速度。拉维格里奥纳说,非洲70%艾滋病病毒感染者得了肺结核后无法获得有效治疗,他们几个月后就会死亡。比如,去年非洲接受了DOTS治疗的艾滋病病毒感染者共有8万,但因缺乏治疗死于肺结核的艾滋病病毒感染者却有20多万
世界卫生组织估算,亚洲情况也不容乐观,因为三分之二感染结核菌的人口集中在亚洲。在亚洲的部分地区,70%的艾滋病病毒感染者已患有肺结核,亚洲死于肺结核的艾滋病病毒感染者人数目前每年增加2倍。
鉴于这种危险情况,世界卫生组织在南非国际艾滋病大会召开之际,呼吁在艾滋病病毒感染者中普及抗肺结核药物,并与艾滋病药物治疗相结合,提高病人的生活质量,延长病人的生命,减轻这两大疾病给世界带来的冲击。
世卫组织艾滋病部门负责人说,艾滋病毒感染者中死于肺结核人数的上升,这显示,同时应对这两种传染病需要很好的配合。在与艾滋病毒有关的肺结核病例中,大约79%发生在非洲沙哈拉以南地区,11%在东南亚。在每年出现肺结核新病例最多的五个国家中,两个国家引发了艾滋病感染疫情。而南非是目前受艾滋病和肺结核“双重疾病”威胁最严重的地区之一。
对抗肺结核和艾滋病 中国在行动
在第五届国际艾滋病大会正在南非召开之际,第五轮中国全球基金结核病项目办会同中国疾控中心结控中心专家一行3人对安徽省五轮全球基金结核病/艾滋病(TB/HIV)双重感染领域进行了督导检查。
在安徽界首市和临泉县,督导组实地查看了疾控中心五轮结核病项目双感患者管理资料,药物治疗,患者随访跟踪,患者个人档案及电子档案。同时查看了艾滋病项目办和健康教育相关材料。专家建议,在HIV病人筛查TB患者过程中让HIV病人戴上口罩,避免与TB患者接触造成交叉感染;艾滋病患者取药时要进行结核病问卷调查,艾滋病患者免疫功能低下,抵抗力弱,易发生机会性感染,能从中及时发现结核病人;、双重感染患者建议在治疗TB时,隔日服药改成每天服药,但要注意药物用量,避免造成肝肾功能损害。
为降低耐多药肺结核的患病率和死亡率,控制中国耐多药结核病疫情,第七轮中国全球基金结核病项目启动,分阶段在我国的10个省份实施耐多药结核病治疗管理工作。中国农民工肺结核病人占中国肺结核病例总数的80%。随着大量农民工进城,如何控制大规模的肺结核传染以及肺结核与艾滋病的同时感染一直是巨大的挑战。中国健康联盟旨在推动包括中国政府部门、联合国机构、非政府组织在内的公共机构与私营企业的合作,共同应对艾滋病和肺结核对中国经济和社会造成的威胁。中国健康联盟的核心工作是“民工肺结核和艾滋病工作场所计划”。
“民工是医疗卫生政策和项目最难接触到的人群,而企业是最好的接触他们的环境,因此我们相信中国健康联盟将迈出重要一步。全球健康计划已经获得了企业的协助,可以为500万人提供肺结核和艾滋病医疗服务。”全球健康计划负责人Francesca Boldrini说,“我们的经验证明,当公共机构和私营机构合作处理疾病问题时,往往会带来实质性的变化。”
卫生部副部长黄洁夫表示,卫生部会支持中国健康联盟的发展,坚信这种合作以及联盟合作伙伴的协同竞争效应会给中国的卫生事业的发展带来积极的贡献。
中国健康联盟的另一合作伙伴,联合国发展署HIV艾滋病合作项目负责人Peter Piot说:“与私营企业合作为艾滋病医疗项目在中国的深入发展提供了独特的机会。我希望更多的企业加入。” (本文来源:人民网 )
2009-09-21 18:42:45 Source: People's Network (Beijing)
23-year-old from Anhui Province, Mr. Yang, recently got invasive pulmonary tuberculosis identified. He is now eating a combination of state-provided medication, the Government provided free of charge. He is easy to cold, and sometimes low-grade fever, and cold hard good. Cold when they cough without phlegm. With the medication compared with no significant improvement in the former. Mr. Yang is an AIDS patient, he would often ask: "how can I do?"
According to reports, the size of China's tuberculosis infection among the world's second, after India. China's population is estimated that 45% of latent tuberculosis infection, the current number of cases reached 4.5 million, accounting for 15% of the world. Tuberculosis deaths in China each year over 25 million people living with HIV and tuberculosis and HIV at the same time increasing the risk of infection. China's AIDS epidemic is still expanding. Tuberculosis and AIDS combined, the two diseases may not be just a fate?
Accelerated the spread of AIDS, the prevalence of tuberculosis
In July this year, held in Cape Town, South Africa, Fifth International AIDS Conference, the World Health experts warn that TB has become the current leading cause of death in patients with AIDS, tuberculosis and AIDS therefore should no longer be viewed as two separate issues, The international community should redouble its efforts to deal with the interaction between them.
Medical information, tuberculosis, HIV-infected persons reduced life expectancy; turn HIV virus attacks the immune system, thereby contributing to the spread of TB, and led many TB carriers eventually develop into tuberculosis. In Italy, Rwanda, Spain and the United States to carry out the study found that M. tuberculosis infected with the AIDS virus carriers, the possibility of developing tuberculosis than those not infected with HIV and 30 to 50 times.
In fact, in recent years, the trend of interaction between TB and AIDS is clear, the whole world about every three HIV-infected individuals who have a the same time, contracted tuberculosis. Acting Director of the Department of the World Health Organization tuberculosis Mario? La Weige Leonard, said the World Health Organization declared tuberculosis a global emergency crisis in 10 years after the epidemic of tuberculosis and even become more serious, mainly because of HIV transmission. Need to redouble our efforts to deal with the interaction of these two deadly diseases, they each add to the other side effects.
However, in recent years, the spread of AIDS in Africa so that the prevalence of tuberculosis accelerated greatly exceeded the rate of promotion of DOTS treatment. La Weige Leonard said that 70% of Africa's HIV-infected persons contracted tuberculosis after the lack of access to effective treatment, they will die a few months later. For example, last year, Africa received DOTS treatment of HIV-infected persons a total of 80000, but the lack of treatment died of tuberculosis in HIV-infected persons there are more than 20 million
World Health Organization estimates, the Asian situation is not optimistic, since two-thirds of the population infected with Mycobacterium tuberculosis concentrated in Asia. In parts of Asia, 70% of HIV-infected persons have been suffering from tuberculosis, died of tuberculosis in Asia infected with HIV every year the number increased two-fold.
In view of this dangerous situation, the World Health Organization International AIDS Conference in South Africa, the occasion calls for universal access of HIV infected persons of anti-TB drugs and AIDS combined drug therapy and improve patient's quality of life and prolong life, reduce the These two diseases, the impact of the world.
WHO's AIDS department said that HIV-infected persons die of TB rise in the number, indicating that at the same time deal with these two kinds of infectious diseases requires a great combination. With HIV-related TB cases, about 79% occur in Africa south of Sahara, 11% in Southeast Asia. Emergence of new cases of tuberculosis each year, the largest five countries, the two countries triggered the AIDS epidemic. While South Africa is currently the subject of AIDS and tuberculosis "double disease" one of the areas most threatened.
Fight against tuberculosis and AIDS in China in action
Of the Fifth International AIDS Conference is being held in South Africa the occasion of the fifth round of the China Office of the Global Fund TB project in conjunction with the Chinese Center for Disease Control node control center line of three people in Anhui Province expert 5 Global Fund TB / HIV (TB / HIV) Dual infected areas of supervision and inspection.
Jieshou City and Linquan County in Anhui, the Steering Group to inspect five of the CDC TB management information project pairs of flu patients, drug treatment, patient follow-up tracking individual patient files and electronic files. At the same time see the AIDS Project Office and the health education-related materials. Experts suggest that patients with TB in HIV patients in the course of screening for HIV patients to wear masks, avoid contact with TB patient caused by cross infection; AIDS patients obtain the medicines from time to conduct a survey of TB, AIDS, immune function in patients with low body resistance is weak, easily occurrence of opportunistic infections, from tuberculosis was found in a timely manner;, double recommended in the treatment of TB infection, the next day medication into a daily medication, but should pay attention to drug dosage, to avoid damage to liver and kidney function.
In order to reduce multi-drug resistant tuberculosis morbidity and mortality, control of multi-drug resistant tuberculosis in China, the seventh round of the China Global Fund TB project launched in phases in China's 10 provinces to implement the treatment of MDR-TB management. Chinese migrant workers in China of tuberculosis patients accounted for 80% of the total number of TB cases. With the large number of migrant workers in cities, how to control a large-scale transmission of tuberculosis and tuberculosis are also infected with HIV has been a huge challenge. China Health Alliance to promote including the Chinese government departments, UN agencies, non-governmental organizations, public agencies and private sector cooperation to jointly cope with AIDS and tuberculosis in China's economic and social threats. China Health Alliance's core business is "Labor of tuberculosis and AIDS workplace program."
"Labor is the most difficult medical and health policies and programs accessible to people, but business is the best contact with their environment, we believe that China Health Alliance will be an important step. Global Health program has received the assistance of the enterprise, can be 5 million people with TB and AIDS medical services. "global health project leader, said Francesca Boldrini," Our experience has shown that when public institutions and private institutions dealing with the problem of disease, they tend to bring about substantial change. "
Vice Health Minister Huang Jiefu said the ministry would support the development of the China Health Alliance, believe that cooperation and alliance partners, the synergy effects of competition will give the development of public health in China has brought a positive contribution.
China Health Alliance, another partner, the United Nations Development Program HIV AIDS, Peter Piot co-project leader, said: "AIDS medical care in cooperation with the private sector projects in-depth development of China provides a unique opportunity. I hope that more companies have joined. "(This article Source: People's Network)
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