RESUMO
The tuberculosis (TB) and HIV syndemic continues to rage and are a major public health concern worldwide. This deadly association raises complexity and represent a significant barrier towards TB elimination. TB continues to be the leading cause of death amongst HIV-infected people. This paper reports the challenges that lay ahead and outlines some of the current and future strategies that may be able to address this co-epidemic efficiently. Improved diagnostics, cheaper and more effective drugs, shorter treatment regimens for both drug-sensitive and drug-resistant TB are discussed. Also, special topics on drug interactions, TB-IRIS and TB relapse are also described. Notwithstanding the defeats and meagre investments, diagnosis and management of the two diseases have seen significant and unexpected improvements of late. On the HIV side, expansion of ART coverage, development of new updated guidelines aimed at the universal treatment of those infected, and the increasing availability of newer, more efficacious and less toxic drugs are an essential element to controlling the two epidemics. On the TB side, diagnosis of MDR-TB is becoming easier and faster thanks to the new PCR-based technologies, new anti-TB drugs active against both sensitive and resistant strains (i.e. bedaquiline and delamanid) have been developed and a few more are in the pipeline, new regimens (cheaper, shorter and/or more effective) have been introduced (such as the "Bangladesh regimen") or are being tested for MDR-TB and drug-sensitive-TB. However, still more resources will be required to implement an integrated approach, install new diagnostic tests, and develop simpler and shorter treatment regimens.
Assuntos
Infecções por HIV/epidemiologia , Tuberculose/epidemiologia , Fármacos Anti-HIV/farmacocinética , Fármacos Anti-HIV/uso terapêutico , Antituberculosos/farmacocinética , Antituberculosos/uso terapêutico , Técnicas Bacteriológicas , Ensaios Clínicos como Assunto , Comorbidade , Gerenciamento Clínico , Reservatórios de Doenças , Interações Medicamentosas , Farmacorresistência Bacteriana Múltipla , Infecções por HIV/tratamento farmacológico , Humanos , Síndrome Inflamatória da Reconstituição Imune/fisiopatologia , Síndrome Inflamatória da Reconstituição Imune/terapia , Tuberculose Latente/diagnóstico , Tuberculose Latente/tratamento farmacológico , Programas de Rastreamento/métodos , Mycobacterium tuberculosis/efeitos dos fármacos , Tuberculose/diagnóstico , Tuberculose/tratamento farmacológico , Tuberculose/prevenção & controle , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologiaRESUMO
A presente revisão teve como objetivo apresentar abordagens atuais para o diagnóstico da tuberculose pulmonar em adultos. Novos métodos de cultivo de Mycobacterium tuberculosis e novos testes de biologia molecular foram disponibilizados nos últimos anos. Quanto mais precocemente for realizado o diagnóstico da tuberculose pulmonar, menores serão a morbidade e a mortalidade associadas a ela, como também mais rápida será a interrupção da cadeia de transmissão da doença. Assim, testes rápidos e validados, ao serem incorporados ao diagnóstico da tuberculose pulmonar, poderão ser úteis para o seu controle
This review aims to present current approaches to the diagnosis of pulmonary tuberculosis in adults. In recent years, new methods of Mycobacterium tuberculosis culture have become available, as have new molecular biology methods of tuberculosis screening. Earlier diagnosis of pulmonary tuberculosis results in lower associated morbidity and mortality, as well as earlier interruption of the chain of transmission. Therefore, the incorporation of rapid, validated tests into the diagnostic process could be useful for controlling the disease