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Dual challenge for managing TB/HIV co-infection 結核與愛滋病的雙重管理

(added on 2013/06/13)

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Co-infection of human immunodeficiency virus (HIV) increases the risk of developing tuberculosis (TB) by over 20 times. TB and HIV can interact synergistically, complicating treatment and leading to excess public health burden. This map shows the distribution of TB/HIV cases worldwide, and the percentage of TB patients with documented HIV status in 41 high TB/HIV burden countries in 2011.

As depicted by graduated colours, the highest HIV prevalence among TB incident patients was observed in Southern Africa. The coloured circles with red ribbon represent the proportion of notified TB patients who had been tested for HIV. The green circles for South-eastern Africa indicate that more than 85% had been tested. However, as shown by red circles, less than half of notified TB patients had known HIV status in Central Africa and some high TB/HIV burden countries in Asia. To inform effective management, enhancing coverage of HIV testing among TB patients is important, especially in countries with high prevalence of HIV.

Data for the map were obtained from World Health Organization.

愛滋病病毒感染能增加結核的發病風險超過二十倍。若同時感染愛滋病病毒及結核桿菌，兩種致病原在人體內相互影響，增加治療的難度，並帶來沉重的公共衛生負擔。地圖顯示2011年同時感染愛滋病病毒的結核病人分佈，與及41個愛滋病/結核高發病國家中載有愛滋病病毒感染記錄的結核病人比率。

依地圖顏色所示，非洲南部新增的結核病人中，已知感染愛滋病病毒的比率為全球最高。另外，附有紅絲帶的顏色圓圈圖案顯示結核病者中已知愛滋病病毒感染情況的比率。非洲東南部的綠色圓圈圖案顯示測試率超過百分之八十五。非洲中部及部分愛滋病/結核高負擔的亞洲國家以紅色圓圈圖案代表，反映少於一半結核病人知道自己有否同時感染愛滋病病毒。要計劃有效的結核防控策略，必須提高結核病者的愛滋病病毒抗體測試率，這點對愛滋病高感染國家尤其重要。

地圖資料源自世界衛生組織。

HIV infection 人類免疫力缺乏病毒感染

What is HIV/ AIDS? 什麼是人類免疫力缺乏病毒感染/愛滋病?

The human immunodeficiency virus (HIV) is a retrovirus that infects cells of the human immune system, destroying or impairing their function. In the early stages of infection, there is no symptom. As HIV infection progresses, the immune system becomes weaker, thereby increasing susceptibility to opportunistic infections.
The most advanced stage of HIV infection is acquired immunodeficiency syndrome (AIDS). In the absence of treatment, 50% of the infected individuals progress to AIDS. The use of antiretroviral drugs can reverse the immune deficiency.
人類免疫力缺乏病毒(HIV)是一種感染人類免疫細胞，從而破壞人體免疫系統的反轉病毒。在感染初期，患者可以完全沒有任何病癥。但在感染後期，患者的免疫力會被削弱，容易被其它機會性感染影響。
愛滋病(後天免疫力缺乏症候群) 是人類免疫力缺乏病毒感染的後期嚴重階段。在沒有接受治療的情況下，平均一半感染者在十年內發病，成為愛滋病患者。抗病毒藥物治療可以有效恢復患者免疫能力。

How does HIV spread? 如何傳播？

HIV is transmitted through unprotected sexual intercourse (heterosexuals and homosexuals), transfusion of contaminated blood or blood products, sharing of contaminated needles in injection drug users, and between a mother and her infant during pregnancy, childbirth and breastfeeding.
HIV的傳播途徑包括不安全性接觸 (異性及同性) ，輸入受污染血液或血制品、靜脈吸毒者共用針筒、和母嬰傳播（懷孕、分娩、和哺乳期間）。

Vaccine? Prevention? 如何預防？

A safe and effective vaccine is still under development. The practice of safer sex with the use of condom is one most effective means of preventing HIV infection through sex. Avoidance of needle sharing is important in injection drug users, whereas antiretroviral treatment can be effective in preventing mother-to-child HIV transmission.
預防疫苗至今仍在研究中。現時最有效的預防性傳播方法是採用安全性行為，包括使用安全套。吸毒者應避免共同使用針具，而抗病毒藥物則可以有效預防母嬰傳播。

Tuberculosis 結核病

What is Tuberculosis? 什麼是結核病？

Tuberculosis, or TB, is a bacterial disease caused by Mycobacterium tuberculosis, which most commonly affects the lungs.
In healthy people, infection with Mycobacterium tuberculosis often causes no symptom, since the person’s immune system acts to “wall off” the bacteria. The symptoms of active TB of the lungs are cough, sometimes with sputum or blood, chest pain, general weakness, weight loss, fever and night sweats. Tuberculosis is normally treated with a six to nine-month course of antibiotics.
結核病是由一種名為結核桿菌的細菌所引起的傳染病，通常影響肺部。
受結核桿菌感染的病人，部份因本身的免疫系統發揮作用而不會有任何病癥。而活躍肺結核病的病癥則包括咳嗽，痰涎中帶血、胸口痛、疲倦、體重下降、發燒、夜間冒汗等。結核病者一般需要接受為期六至九個月的抗生素療程治療。

How does it spread? 如何傳播？

TB is transmitted from person to person via droplets from the throat and lungs of people with the active respiratory infection.
結核病是經患者呼吸系統產生的飛沫於空氣中人傳人感染的。

Vaccine? 疫苗?

BCG, or bacillus Calmette-Guérin, is a vaccine for tuberculosis disease. In Hong Kong, all the new born babies receive BCG vaccine as a part of the childhood immunisation programme. Vaccination does not guarantee protection.
卡介苗是用以預防結核病的一種疫苗。每一個香港新生嬰兒需要接受一系列免疫接種，當中包括卡介苗注射。接種卡介苗並不保證不受結核桿菌感染。