Subject(s)
Humans , Communicable Disease Control/trends , Tuberculosis/therapy , Chile/epidemiology , Communicable Disease Control/organization & administration , National Health Programs/organization & administration , National Health Programs/trends , Tuberculosis/epidemiology , Tuberculosis/prevention & controlABSTRACT
At present, human immunodeficiency virus (HIV) is thought to have infected over 17 million people worldwide, over 1 million in North America and the Caribbean. By comparison, infection with the tuberculosis (TB) agent Mycobacterium tuberculosis is far more common, current estimates indicating that roughly one-third of the world's population is infected. These two infections tend to aggravate each other. That is, HIV leads to a progressive immune system depression that favors reactivation of TB in people with latent tuberculosis infections; it promotes progression of TB primary infections or reinfections to full-blown tuberculosis disease; and it fosters TB transmission, because those simultaneously infected with HIV and M. tuberculosis tend to develop a baciliferous and contagious TB that can be transmitted to other susceptible individuals, even though the latter are HIV-negative. In addition, this coinfection tends tok promote circulation of drug-resistant M. tuberculosis and to produce peculiar manifestations that complicate TB diagnosis, treatment, and control. Overall, it seems clear that the growing threat posed by these associated agents demands effective action in the form of well-coordinated measures involving thoroughgoing participation by all countries (AU)
Subject(s)
Humans , Male , Female , Adult , Acquired Immunodeficiency Syndrome/epidemiology , HIV Infections/epidemiology , Tuberculosis/epidemiology , West Indies/epidemiology , IncidenceABSTRACT
Chile ha sido un país pionero en realizar estudios controlados para evaluar la eficacia de la quimioterapia abreviada antituberculosa. En esta revisión se analizan los estudios clínicos sobre quimioterapia efectuados en Chile por un período de 10 años a contar de 1978. El propósito de estos ensayos ha sido buscar el esquema más satisfactorio de quimioterapia en cuanto a eficacia, seguridad, aceptabilidad, aplicabilidad y bajo costo económico. Los estudios analizados se efectuaron en 6 áreas sanitarias diferentes de Santiago de Chile y el el área de Valparaíso, las cuales son cubiertas por el Sistema Nacional de Servicios de Salud. Los estudios fueron coordinados por un grupo de especialistas y un total de 3616 pacientes con tuberculosis pulmonar con baciloscopía positiva fue incorporada a 8 esquemas diferentes de quimioterapia. El éxito de los esquemas quimioterapéuticos analizados fluctuó entre 88.1 y 98.6 porciento, las recaídas entre el 0.7 y 10.9 porciento y los fracasos entre 0 y 1.8 porciento. Se obtuvo inactivación de la tuberculosis entre el 73 y el 87.4 porciento de los casos. Los efectos secundarios de las quimioterapias fluctuaron entre 0 y 7.2 porciento y los abandonos entre 8 y 22.1 porciento. La mortalidad fluctuó entre 1.1 y 4.1 porciento. El costo de las drogas admnistradas en cada tratamiento individual varió entre 32.60 y 65.90 dólares estadounidenses. Se concluye que con cualquiera de los dos siguientes esquemas de quimioterapia abreviada es posible obtener entre 97 y 98 porciento de eficacia: a) siete meses de quimioterapia, con un primer mes de tratamiento diario con Estreptomicina (S), Isoniacida (H), Rifampicina (R) y Pirazinamida (Z) seguido por H + R dos veces por semana (ISHRZ/6H2R2), o b) cinco meses de quimioterapia, con los dos primeros meses de tratamiento diario con la misma asociación de cuatro drogas seguido por 3 meses de H + R bisemanal (2SHRZ/9H2R2). Indudablemente el segundo esquema aumenta los costos y requiere el empleo de una mayor infraestructura en la fase diaria
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Drug Administration Schedule , Tuberculosis/drug therapy , Antibiotics, Antitubercular/administration & dosage , Tuberculosis/epidemiologyABSTRACT
Tuberculosis was highly prevalent in Chile during the first half of the present century. The mortality rate, for instance, remained around 250 per 100.000 of population for over 50 years. During the first decade after the introduction of effective chemotherapy for tuberculosis, mortality fell to 57 per 100.000 (1959). This decrease in mortality was even more rapid in children due to a BCG nationwide vaccination program. In spite of the many medical efforts done, tuberculosis has decreased at a much lower rate during the last decades. In 1979 there still was an incidence of bacillogenic cases of 75 per 100.000 of the population over 15 years of age with a global mortality of 16 per 100.000. We hope that the new program of control and the extension of the short-course treatment for tuberculosis and an increase in the population covered by the health system will change the current unsatisfactory panorama of tuberculosis in Chile.(AU)
