英语翻译
Discussion
TheuseofRIF/PZAamongimmigrantsinthisout-breakwasassociatedwithahighincidenceofhepato-toxicity,acompletionratewellbelowtheCDC’s85%target,(5)andculturalandfinancialbarrierstotreatmentandmonitoring.
The17%ofadultsexperiencingadrug-inducedhepatitisisconsistentwithpriorreportsamongnon–HIV-infectedpersons.(10,14)Theincidenceofhepatotoxicityinclinicaltrialsofnon–HIV-infectedpersonsisapproximately8%(14);however,otherhealthdepartmentshavereportedhigherrates.(15,16)Differencesmaybeduetodifferencesinpatientpopulations,monitoring,anddefinitionsofhepatitis.Whilethisexperienceconfirmstheimportanceofclosemonitoring,thehealthdepartmentfoundthatlinguisticbarriersandculturalbeliefsaboutgivingbloodhinderedmonitoringandmayhavedecreasedadherence.
Thekeylimitationtothisstudyisthesmallnumberofsubjects,whichdoesnotallowforpopulationinferences,comparisonswithclinicaltrials,orafullexplorationofriskfactorsforhepatitis.Relianceonchartbaseddataandself-reportsmayhaveunderestimatedprevalenceofcomorbiditiesandalcoholuseduringtreatmentandcontributedtothehighrateofhepatotoxicity.Whiletherewerelimitedsideeffectsandahighcompletionrateforchildren,4monthsofri-fampinremainsthestandardofcareinchildrenexposedtoisoniazid-resistanttuberculosisbecauseoflimiteddataonRIF/PZAinchildren.(5,13)ThecostsassociatedwithRIF/PZAareunderestimatedbecausefollow-uptestingandinterpretertimewerenotincluded.
Thiscasestudymayassisthealthcareprovidersfacingsimilardecisionsabouttuberculosispreventioninrecentimmigrants.Resourcesshouldbedirectedtowardimprovingthehealthcaresystem’sabilitytoprovideculturallyappropriatecarebecausethismayimproveadherencetocurrent,less-toxictherapies.(4,17–19)Althoughmobileimmigrantsmaybenefitfromshort-coursepreventivetherapy,potentialbenefitsmustbeweighedagainstpotentialhepatotoxicity,cost,andculturalbarriers.
WearegratefultoKarenGrush,JaneLux,andAnaRodriguezattheDeKalbCountyHealthDepartment,andMarg