Risk factors for default from tuberculosis treatment in HIV-infected individuals in the state of Pernambuco, Brazil: a prospective cohort study

Abstract

BackgroundConcomitant treatment of Human Immunodeficiency Virus (HIV) infection and tuberculosis (TB) presents a series of challenges for treatment compliance for both providers and patients. We carried out this study to identify risk factors for default from TB treatment in people living with HIV.MethodsWe conducted a cohort study to monitor HIV/TB co-infected subjects in Pernambuco, Brazil, on a monthly basis, until completion or default of treatment for TB. Logistic regression was used to calculate crude and adjusted odds ratios, 95% confidence intervals and P-values.ResultsFrom a cohort of 2310 HIV subjects, 390 individuals (16.9%) who had started treatment after a diagnosis of TB were selected, and data on 273 individuals who completed or defaulted on treatment for TB were analyzed. The default rate was 21.7% and the following risk factors were identified: male gender, smoking and CD4 T-cell count less than 200 cells/mm3. Age over 29 years, complete or incomplete secondary or university education and the use of highly active antiretroviral therapy (HAART) were identified as protective factors for the outcome.ConclusionThe results point to the need for more specific actions, aiming to reduce the default from TB treatment in males, younger adults with low education, smokers and people with CD4 T-cell counts < 200 cells/mm3. Default was less likely to occur in patients under HAART, reinforcing the strategy of early initiation of HAART in individuals with TB.

A Study on HIV/TB Co-infection in and around Khammam, Telangana, India

“…This clearly shows that TB coinfection increases in HIV positive individuals with decrease in CD4 cell count. Similar observations were done by some studies where CD4 cell counts were <200cells/mm 3 and severe immunosuppression in HIV/TB co-infected individuals when compared to HIV infection alone (Kamath et al, 2013;Belay et al, 2013;Taha M Deribew et al, 2011;Giri et al, 2013;Maruza et al, 2011). It is also important to detect MDR-TB in India where TB is endemic with a prevalence of 3% in new cases and 12-18% in old tested cases (Chauhan, 2008) the sensitivity of sputum microscopy will be less in HIV/TB coinfection but can be detected better by CBNAAT.…”

Tuberculosis treatment default in a large tertiary care hospital in urban Nigeria: Prevalence, trend, timing and predictors

“…We did not interview the patients nor could we collect additional data. Furthermore, as has previously been suggested, Directly Observed Therapy (DOT) is not operationally feasible in referral hospitals [26]. Some of the sampled defaulters in our study were not traced, whereas others might have died, but the treatment center was not notified.…”

Role of Diabetes in prevalence of Tuberculosis

“…The risk of developing TB is estimated to be between 20-37 times greater in people living with HIV than among people those who are without HIV infection. TB is a leading cause of morbidity and mortality among people living with HIV [25].…”