Preditores dos desfechos do tratamento da tuberculose

Abstract

Objective: To analyze tuberculosis treatment outcomes and their predictors. Methods: This was a retrospective longitudinal cohort study involving tuberculosis patients treated between 2004 and 2006 at the Instituto de Pesquisa Evandro Chagas, in the city of Rio de Janeiro. We estimated adjusted risk ratios (ARRs) for the predictors of treatment outcomes. Results: Among 311 patients evaluated, the rates of cure, treatment abandonment, treatment failure, and mortality were 72%, 19%, 2%, and 6%, respectively. Changes in the treatment regimen due to adverse events occurred in 8%. The factors found to reduce the probability of cure were alcoholism (ARR, 0.30), use of the streptomycin+ethambutol+ofloxacin (SEO) regimen (ARR, 0.32), HIV infection without the use of antiretroviral therapy (ART; ARR, 0.36), and use of the rifampin+isoniazid+pyrazinamide+ethamb utol regimen (ARR, 0.58). Being younger and being alcoholic both increased the probability of abandonment (ARR, 3.84 and 1.76, respectively). It was impossible to determine the ARR for the remaining outcomes due to their low prevalence. However, using the relative risk (RR), we identified the following potential predictors of mortality: use of the SEO regimen (RR, 11.43); HIV infection without ART (RR, 9.64); disseminated tuberculosis (RR, 9.09); lack of bacteriological confirmation (RR, 4.00); diabetes mellitus (RR, 3.94); and homosexual/bisexual behavior (RR, 2.97). Low income was a potential predictor of treatment failure (RR, 11.70), whereas disseminated tuberculosis and HIV infection with ART were potential predictors of changes in the regimen due to adverse events (RR, 3.57 and 2.46, respectively). Conclusions: The SEO regimen should not be used for extended periods. The data confirm the importance of ART and suggest the need to use it early.Keywords: Tuberculosis; HIV; Rifampin; Drug toxicity; Risk factors; Medication adherence. ResumoObjetivo: Analisar os desfechos do tratamento da tuberculose e seus preditores. Métodos: Estudo longitudinal de coorte de pacientes com tuberculose tratados entre 2004 e 2006 no Instituto de Pesquisa Evandro Chagas, na cidade do Rio de Janeiro. As razões de risco ajustadas (RRa) dos preditores foram estimadas. Resultados: Foram incluídos 311 pacientes. As taxas de cura, de abandono, de mortalidade e de falha terapêutica foram, respectivamente, 72%, 19%, 6% e 2%. A troca de regime terapêutico por eventos adversos foi necessária em 8%. O alcoolismo (RRa, 0,30), uso do regime estreptomicina+etambutol+ofloxacina (SEO; RRa, 0,32), infecção por HIV sem tratamento antirretroviral (TARV; RRa, 0,36) e o uso do regime rifampicina+isoniazida+pirazinamida+etambutol (RRa, 0,58) reduziram a probabilidade de cura. A faixa etária mais jovem (RRa, 3,84) e o alcoolismo (RRa, 1,76) aumentaram a probabilidade do abandono. Não foi possível determinar as RRa para os demais desfechos devido a suas baixas prevalências. Entretanto, medidas do risco relativo (RR) identificaram os seguintes potenciais preditores do óbito: uso de esquema SEO (RR,1...

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

“…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. Cases reported in blacks and browns had a higher chance of abandoning treatment compared with the indigenous.…”

“…As seen in other investigations, 3,4,5,7,12 the present findings reinforce the hypothesis that the indigenous in Brazil are more vulnerable to falling ill from tuberculosis compared Abandoning treatment proved to be associated with being male and with being in the 20 to 44 year old age group, as in other contexts. 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.…”

“…These factors impede achieving a cure, as they increase the duration and cost of treatment. 1,19,20 Such failures are usually associated with alcohol use and co-infection with HIV, more frequent in vulnerable populations. 18 In Brazil, as in other countries, TB is linked to poor living conditions, with marked inequalities in the distribution of the disease.…”

Comunicação para promoção da saúde: as campanhas publicitárias sobre tuberculose no Brasil

“…17 Estudos epidemiológicos demonstram que a incidência de tuberculose é maior entre sujeitos que não dispõem de moradia ou que vivem em locais impróprios para preservação de sua integridade como pessoa; pessoas em situação de desemprego ou de baixa renda; e que apresentam baixo nível de escolaridade e/ou estão coinfectados pelo HIV. [18][19] Neste sentido, fica evidente que a tuberculose é apenas mais um elemento de um contexto de vulnerabilidades prévias e/ou adjacentes à própria doença. Tal análise remete ao questionamento sobre a viabilidade da aposta de que o diagnóstico e o tratamento da tuberculose vão tornar o indivíduo saudável.…”

“…17 Essa crítica evidencia certo julgamento moral, onde quem não se cuida é ignorante, negligente ou irresponsável. [12][13][14][15][16][17][18][19][20] Em recente avaliação de campanhas publicitárias em saúde, um estudo concluiu que as mesmas trazem mensagens unidirecionais e de apelo afetivo para promover a adesão aos tratamentos medicamentosos. 21 Destacou-se o caráter moralista das mensagens das campanhas, evidenciando a ênfase na obrigação moral do sujeito em aderir ao ato saudável, tendo em vista os deveres do bom cidadão.…”