Mortality, TB/HIV co-infection, and treatment dropout: predictors of tuberculosis prognosis in Recife, Pernambuco State, Brazil

Abstract

This non-concurrent cohort study aims to identify predictors of tuberculosis mortality in a large population database in Brazil. Tuberculosis, death, and TB/HIV cases were validated respectively from the tuberculosis surveillance (SINAN/TB), mortality (SIM), and SINAN/AIDS databases for a five-year period. Analysis included proportional hazard models with relative risk estimates. Out of 5,451 individuals reported with tuberculosis, 320 (5.9%) died (incidence and mortality rates of 98.6 and 12.2/100 thousand inhabitants, respectively). After adjustment, relative risk of dying from tuberculosis was 9.8 for individuals>50 years of age; 9.0 for TB/HIV co-infection; 3.0 for mixed TB clinical presentation; and 2.0 for treatment dropout. In the multivariate model, using cases with HIV/AIDS, all adjusted predictors lost significance except mixed clinical presentation (RR 1.9; 1.1-3.1). TB/HIV co-infection is an important predictor of TB mortality. However, among individuals without HIV/AIDS, mortality is still highly associated with older age, mixed clinical forms, and treatment dropout.

Magnitude da tuberculose pulmonar na população fronteiriça de Mato Grosso do Sul (Brasil), Paraguai e Bolívia

“…O elevado abandono (13,1%) na população não indígena da fronteira pode advir de dificuldades na adesão ao tratamento, incluindo fatores como tabagismo, uso de drogas e bebidas alcoólicas, baixa escolaridade, efeitos adversos dos agentes quimioterápicos, coinfecção por HIV e abandono prévio, além de outras desvantagens socioeconômicas 42 . Na população indígena, a despeito da precariedade das condições socioeconômicas e outros agravantes, a cobertura oferecida pela Estratégia Saúde da Família (ESF) e pela ampliação do Tratamento Diretamente Observado (TDO) tem sido mostrado efetiva 35,36 , o que possivelmente explica a associação entre ser indígena e não abandonar o tratamento de tuberculose pulmonar.…”

Desigualdades sociais e tuberculose: análise segundo raça/cor, Mato Grosso do Sul

“…1,19,20,23 This phenomenon may be related to factors that make it difficult to adhere to treatment, including smoking, drug and alcohol use, low levels of schooling, the adverse effects of the medication, co-infection with HIV and previous abandonment, in addition to other socioeconomic disadvantages. 13 Abandoning treatment compromises one of the pillars of the program for controlling tuberculosis (PCT), treatment, which can be decisive in the path of the disease and lead to complications, including multidrug-resistant TB and death. 1,19,20,23 The indigenous population had the highest rates of cure during the period, as described by Croda et al 12 in Dourados, MS, Midwestern Brazil.…”

Factors associated with death among HIV‐uninfected TB patients in Thailand, 2004–2006

“…Although most TB deaths can be averted through prompt diagnosis and initiation of appropriate chemotherapy, death during TB treatment is also an important public health challenge (Floyd & Wilkinson 1997;Dye et al 2005;Maher & Raviglione 2005;Stop TB Partnership WHO 2006). In countries with HIV epidemics, the strongest predictor of death during TB treatment is HIV infection (Domingos et al 2008;Sanguanwongse et al 2008). Among HIV-infected patients receiving TB treatment, antiretroviral therapy is the most important determinant of survival during TB treatment (Manosuthi et al 2006;Akksilp et al 2007;Sungkanuparph et al 2007;Tansuphasawadikul et al 2007;Sanguanwongse et al 2008).…”