Outcomes of TB Treatment by HIV Status in National Recording Systems in Brazil, 2003–2008

Abstract

BackgroundAlthough the Brazilian national reporting system for tuberculosis cases (SINAN) has enormous potential to generate data for policy makers, formal assessments of treatment outcomes and other aspects of TB morbidity and mortality are not produced with enough depth and rigor. In particular, the effect of HIV status on these outcomes has not been fully explored, partly due to incomplete recording in the national database.Methodology/Principal FindingsIn a retrospective cohort study, we assessed TB treatment outcomes, including rates of cure, default, mortality, transfer and multidrug resistant TB (MDR-TB) among a purposively chosen sample of 161,481 new cases reported in SINAN between 2003 and 2008. The study population included all new cases reported in the six States with the highest level of completeness of the HIV status field in the system. These cases were mostly male (67%), white (62%), had pulmonary TB (79%) and a suspect chest X ray (83%). Treatment outcomes were best for those HIV negative cases and worst for those known HIV positive patients (cure rate of 85.7% and 55.7% respectively). In multivariate modeling, the risk of having an unfavorable outcome (all outcomes except cure) was 3.09 times higher for those HIV positive compared with those HIV negative (95% CI 3.02–3.16). The risk of death and default also increased with HIV positivity. The group without a known HIV status showed intermediate outcomes between the groups above, suggesting that this group includes some with HIV infection.ConclusionsHIV status played an important role in TB treatment outcomes in the study period. The outcomes observed in those with known HIV were poor and need to be improved. Those in the group with unknown HIV status indicate the need for wider HIV testing among new TB cases.

Mortality related to tuberculosis-HIV/AIDS co-infection in Brazil, 2000-2011: epidemiological patterns and time trends

“…The presence of variables consid- Table 3 Joinpoint regression analysis of mortality rates related to TB-HIV/AIDS co-infection by region, sex and age group. ered indicators for poverty in Brazil and a higher risk among those with a low education and the black population, confirms the increased mortality in these regions 6,9,10,15,16,26,27 . Similar to other infectious diseases, poverty may have increased the vulnerability for TB and HIV/AIDS cases.…”

“…HIV/AIDS is being spread within the poorest populations in the country, with negative impacts on clinical and epidemiological aspects 22,27 . In cases with TB-HIV/AIDS co-infection, poverty has previously been shown to be related to higher mortality rates 10,26,29 .…”

When is TB-Aids co-infection treatment discontinued? An analysis of the situation in Brazil

“…It is also necessary to increase our epidemiological knowledge of TB-AIDS co-infection, so that both infections can be treated specifically, as this patient group is three times more vulnerable to therapeutic failure than are non co-infected patients [23,24].…”

“…Thus, it is evident that TB is one of the main causes of mortality in patients with AIDS. Apart from treatment dropout, immune depression and multiresistant TB aggravate the probability of mortality [4,23,28].…”

“…In this context, the monitoring and periodic updating of TB and AIDS information systems are essential to enable a proper evaluation of the interventions carried out, so that appropriate public health actions to control these diseases can be implemented, and to reveal which population groups are most vulnerable to co-infection [23,29].…”