Tuberculose como doença definidora de síndrome da imunodeficiência adquirida: dez anos de evolução na Cidade do Rio de Janeiro

Soares, Elizabeth; Saraceni, Valéria; Lauria, Lilian de Mello; Pacheco, Antônio Guilherme; Durovni, Betina; Cavalcante, Solange

doi:10.1590/s1806-37132006000500012

Cited by 7 publications

(3 citation statements)

References 6 publications

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“…AIDS mortality has also been stable since 1999 despite the increase in HAART distribution. Though the proportion of patients developing tuberculosis after AIDS declined between 1993 and 2002, the magnitude of decrease was substantially less than that seen with other opportunistic infections, such as pneumocystis pneumonia and toxoplasmosis [18] and the proportion of AIDS patients who were later diagnosed with tuberculosis remained stable. Moreover, the majority (75%) of active tuberculosis cases diagnosed among AIDS patients was diagnosed within 30 days of AIDS diagnosis and there was no significant reduction in the proportion of tuberculosis cases diagnosed within 30 days of an AIDS diagnosis after 1998.…”

Section: Discussionmentioning

confidence: 91%

AIDS-Related Tuberculosis in Rio de Janeiro, Brazil

et al. 2008

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BackgroundWe studied the incidence of tuberculosis, AIDS, AIDS deaths and AIDS-TB co-infection at the population level in Rio de Janeiro, Brazil where universal and free access to combination antiretroviral therapy has been available since 1997.Methodology/Principal FindingsThis was a retrospective surveillance database match of Rio de Janeiro databases from 1995–2004. Proportions of tuberculosis occurring within 30 days and between 30 days and 1 year after AIDS diagnosis were determined. Generalized additive models fitted with cubic splines with appropriate estimating methods were used to describe rates and proportions over time. Overall, 90,806 tuberculosis cases and 16,891 AIDS cases were reported; 3,125 tuberculosis cases within 1 year of AIDS diagnosis were detected. Tuberculosis notification rates decreased after 1997 from a fitted rate (fR per 100,000) of 166.5 to 138.8 in 2004. AIDS incidence rates increased 26% between 1995 and 1998 (30.7 to 38.7) followed by a 33.3% decrease to 25.8 in 2004. AIDS mortality rates decreased dramatically after antiretroviral therapy was introduced between 1995 (27.5) and 1999 (13.4). The fitted proportion (fP) of patients with tuberculosis diagnosed within one year of AIDS decreased from 1995 (24.4%) to1998 (15.2%), remaining stable since. Seventy-five percent of tuberculosis diagnoses after an AIDS diagnosis occurred within 30 days of AIDS diagnosis.Conclusions/SignificanceOur results suggest that while combination ART should be considered an essential component of the response to the HIV and HIV/tuberculosis epidemics, it may not be sufficient alone to prevent progression from latent TB to active disease among HIV-infected populations. When tuberculosis is diagnosed prior to or at the same time as AIDS and ART has not yet been initiated, then ART is ineffective as a tuberculosis prevention strategy for these patients. Earlier HIV/AIDS diagnosis and ART initiation may reduce TB incidence in HIV/AIDS patients. More specific interventions will be required if HIV-related tuberculosis incidence is to continue to decline.

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Section: Discussionmentioning

confidence: 91%

AIDS-Related Tuberculosis in Rio de Janeiro, Brazil

et al. 2008

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“…Despite the access to HAART, AIDS-related diseases are still important causes of death in some regions of the country, especially OI, such as pulmonary pneumocystosis and tuberculosis [11][12][13][14]. The city of Catanduva, located in the Southeastern Brazil is among the 100 municipalities with the greatest incidence of AIDS cases in the country [6].…”

Section: Introductionmentioning

confidence: 99%

Epidemiological Patterns of AIDS in a Reference Center from Catanduva, São Paulo State, Brazil

Schiesari¹,

Galisteu²,

Cardoso³

et al. 2012

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Objective: Hereby we present the epidemiological and clinical profile of HIV-infected population before and during the highly active antiretroviral therapy (HAART) era from a tertiary care hospital in the Southeastern region of Brazil. Methods: A retrospective, cross-sectional and descriptive study was carried out, this involved the analysis of the medical records of patients diagnosed with HIV-1/AIDS admitted to Hospital Escola Emílio Carlos, located in the municipality of Catanduva, State of São Paulo, Brazil. Results: In both pre-HAART and HAART periods, HIV-1 infection was more prevalent in men. Heterosexuality and secondary education were associated with AIDS in the HAART period. Statistically significant association was only observed for co-infection with HIV-1/Hepatitis C in the pre-HAART era and the number of patients with opportunistic infection (OI) was lower in the HAART period. Among all OI it is worth mentioning pulmonary pneumocystosis, which despite being common in two periods, its occurrence was considerably greater in the pre-HAART era. Concerning the distribution of OIs according to the HIV-1 viral load and serial count of T CD4 + lymphocytes, a significant association was observed. The association between the number of deaths by OIs and death in the 1st year of diagnosis in the HAART treatment was significant. Conclusions: The clinical and epidemiological profile of a specialized HIV-1/AIDS center in Catanduva, Southeastern Brazilian region, is consistent with the epidemiology of AIDS in the country.

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“…In Brazil, studies of IPT in PLHIV demonstrate reduced incidence of active TB 10 and improved survival 11 that is additive to the impact of HAART. Brazil has a high burden of TB in PLHIV 12,13,14 , with most recent estimates stating that 9% of HIV deaths are due to TB 15 . Brazilian guidelines recommending tuberculin skin tests and isoniazid preventive therapy for PLHIV have existed since 1995 16 and recent recommendations from the World Health Organization restate the need for IPT for PLHIV, though evidence in Brazil suggests that physicians do not adhere strictly to these guidelines 17 .…”

Section: Introductionmentioning

confidence: 99%

Prevalent Tuberculosis at HIV Diagnosis in Rio de Janeiro, Brazil

Saraceni

Cohn

Cavalcante

et al. 2014

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background Although Brazil has model HIV care programs, many patients continue to present late to care. We studied the frequency of tuberculosis (TB) diagnosed at HIV diagnosis in Rio de Janeiro, Brazil, in order to quantify missed opportunities for TB prevention. Methods People living with HIV (PLHIV) and enrolled in the TB/HIV in Rio (THRio) study between 1 September 2005 and 31 August 2009 were included. Prevalent TB was defined as TB diagnosed within 60 days of HIV diagnosis or HIV diagnosis during TB therapy. Survival was measured from HIV diagnosis. We conducted Kaplan-Meier survival plots and Cox regression analyses. Results 4,548 newly diagnosed PLHIV were enrolled; 476(10.5%) with prevalent TB. Prevalent TB cases were older, had lower CD4 counts and higher viral loads than those without TB. Median time to receiving highly active antiretroviral therapy (HAART) in prevalent TB cases was 99 days(IQR=58–191) vs. 126 days(IQR=63–301) in those without TB(p=0.021). Among prevalent TB cases, 17% died during follow-up compared to 8% among non-TB cases(p<0.001). After adjustment for sex, age, baseline CD4 and baseline viral load, risk of death remained significantly higher among prevalent TB cases[aHR=1.72(CI 95% 1.19–2.48)]. Conclusions More than 10% of newly PLHIV in our study presented to care with concurrent active TB disease and thus missed the opportunity for TB preventive therapy. Despite initiating HAART more quickly, these were at significantly greater risk of death. Earlier HIV diagnosis is necessary to provide earlier initiation of HAART and TB preventive therapy to reduce morbidity and mortality in PLHIV.

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Tuberculose como doença definidora de síndrome da imunodeficiência adquirida: dez anos de evolução na Cidade do Rio de Janeiro

Cited by 7 publications

References 6 publications

AIDS-Related Tuberculosis in Rio de Janeiro, Brazil

AIDS-Related Tuberculosis in Rio de Janeiro, Brazil

Epidemiological Patterns of AIDS in a Reference Center from Catanduva, São Paulo State, Brazil

Prevalent Tuberculosis at HIV Diagnosis in Rio de Janeiro, Brazil

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Tuberculose como doença definidora de síndrome da imunodeficiência adquirida: dez anos de evolução na Cidade do Rio de Janeiro

Cited by 7 publications

References 6 publications

AIDS-Related Tuberculosis in Rio de Janeiro, Brazil

AIDS-Related Tuberculosis in Rio de Janeiro, Brazil

Epidemiological Patterns of AIDS in a Reference Center from Catanduva, S&#227;o Paulo State, Brazil

Prevalent Tuberculosis at HIV Diagnosis in Rio de Janeiro, Brazil

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Epidemiological Patterns of AIDS in a Reference Center from Catanduva, São Paulo State, Brazil