Severe HIV-associated pulmonary Tuberculosis: 2006-2016

Abstract

Background: Globally people living with HIV (PLHIV) are 19 times more likely to fall ill with Tuberculosis (TB) than those without HIV. In 2015 0.4 million PLHIV estimated to have died from TB. Aims: to evaluate the clinical features of severe HIV-associated pulmonary TB and determine factors related with mortality.Methods & Materials: Among 1122 PLHIV admitted to the intensive care unit (ICU) of an Infectious Diseases Hospital between 2006 and 2016, 135 had pulmonary TB (PTB). Comorbid diagnoses, clinical features, radiological and laboratory investigations, and outcomes were reviewed. Univariate analysis was performed to identify factors related to death. We performed descriptive statistics on percentage (%), median (Me), mean (M) and range. A p value of < 0.05 was considered significant Results: Incidence of 0,1203, increasing 85% from 2006 to 2016. 62% were male. Me/M age were 40/38 years (14-74). The median duration of ICU care: 7 (1-35) days. 76% had evolved to Aids for more than a year. 95% presented hypoalbuminemia (< a 3,5 g/l), weight loss >10% in 6 last months and/or Karnofsky score ≤50. Only 10% were receiving highly active antiretroviral therapy (HAART). 7% had CD4 ≥200 cells/mm 3 , none of them died, 93% had CD4 <200 célls and 50% died. 8% were coinfected with hepatitis C, 19% had liver failure (LF) and 88% of them died. Respiratory insufficiency (RI) was observed in 59% and 66% died. 42% required mechanical ventilation (MV). 84% had at admission an APACHE II score (Acute Physiology And Chronic Health Evaluation II) ≥13 points. Overall mortality was 51%. Evolution to Aids greater than a year, not receiving HAART, weight loss, hipoalbuminemia, Karnofsky score, CD4 count, MV, RI, LF and APACHE II score ≥13 were significantly associated with mortality (p < 0,05). Conclusion:Higher incidence of PTB in PLHIV/Aids in 2015-2016 was observed. Poor adherence to HAART, deficient immunological and nutritional status and severe PTB were associated with mortality. We encouraged to achieve a proper and early diagnosis and treatment of both pathologies, to improve prognosis of these patients.