Survival of people living with HIV who defaulted from tuberculosis treatment in a cohort, Recife, Brazil

Abstract

BackgroundTuberculosis is a serious public health problem worldwide. It is the leading cause of death amongst people living with HIV, and default from tuberculosis (TB) treatment in people living with HIV increases the probability of death. The aim of this study was to estimate the survival probability of people living with HIV who default treatment for TB compared to those who complete the treatment.MethodsThis was a longitudinal cohort study of people living with HIV, from June 2007 to December 2013 with two components: a retrospective (for those who started tuberculosis treatment before 2013 for whom failure (death) or censoring occurred before 2013), and prospective (those who started tuberculosis treatment at any time between 2007 and June 2013 and for whom death or censoring occurred after the beginning of 2013), at two referral hospitals for people living with HIV (Correia Picanço Hospital - HCP and at Hospital Universitário Oswaldo Cruz – HUOC), in Recife/PE. A total of 317 patients who initiated TB treatment were studied. Default from TB treatment was defined as any patient who failed to attend their pre-booked return appointment at the health center for more than 30 consecutive days, in accordance with Brazilian Ministry of Health recommendations.ResultsFrom a cohort of 2372 people living with HIV we analyzed 317 patients who had initiated TB treatment. The incidence of death was 5.6 deaths per 100 persons per year (CI 95% 4.5 to 7.08). Independent factors associated with death: default from TB treatment 3.65 HR (95% CI 2.28 to 5.83); CD4 < 200 cells/mm3 2.39 HR (95% CI 1.44 to 3.96); extrapulmonary tuberculosis 1.56 HR (95% CI 0.93 to 2.63); smoking 2.28 HR (95% CI 1.33 to 3.89); alcohol light 0.13 HR (95% CI 0.03 to 0.56).ConclusionThe probability of death in people living with HIV who default TB treatment is approximately four times greater when compared to those who do not default from treatment.

Structural Prediction and Mutational Analysis of Rv3906c Gene of Mycobacterium tuberculosis H37Rv to Determine Its Essentiality in Survival

“…M. tuberculosis and HIV together debilitate the insusceptible framework by diminishing CD4+ T lymphocytes and lessening the host survival [ 14 ]. Individuals with this codisease have troublesome treatment result because of official multifaceted nature of these pathogens [ 15 ]. Antiretroviral treatment (ART) is prescribed for HIV-TB cotainted people in beginning period of contamination since it indicates expanded HIV-TB cocontaminated host survival [ 16 ].…”

Predictors of Mortality among Individuals with Tuberculosis and Human Immunodeficiency Virus Coinfection at a Reference Center in Southeastern Brazil: A Retrospective Cohort Study

“…Even with the incentive for the early diagnosis of HIV in Brazil, this is not yet the case and late diagnosis is a public health problem. 35 This study had some limitations. The study was conducted in a single reference hospital that provides treatment to patients with infectious diseases and outpatient care.…”

“…T lymphocyte count lesser 200 cells/mm 3 were more likely to die, which is similar to the results of other studies. 5,35 A low CD4+ T lymphocyte count in patients with TB/HIV indicates that these patients were probably diagnosed late. Even with the incentive for the early diagnosis of HIV in Brazil, this is not yet the case and late diagnosis is a public health problem.…”

Análisis de letalidad en pacientes con diagnóstico de tuberculosis en un centro de alta complejidad en Cali, Colombia

“…Nuestros hallazgos con respecto a las co-morbilidades son coherentes con lo reportado en la literatura científica, donde la principal causa de muerte en pacientes con TBC es la co-infección con SIDA y las complicaciones derivadas como otras infecciones oportunistas 1,21,22 . Se encontró en este estudio concomitancia entre TBC y cáncer en 16% de los pacientes; este hallazgo cada vez es más frecuente en la literatura médica, especialmente en cáncer de pulmón, lo que demuestra la necesidad de tamizar la infección latente por TBC de los pacientes con cáncer y evaluar la presencia de malignidad en pacientes con diagnóstico de TBC en zonas endémicas 19,23 .…”