Tuberculose, HIV e pobreza: tendência temporal no Brasil, Américas e mundo

Abstract

Objective: To analyze the temporal trends of the incidence and prevalence of tuberculosis, with and without HIV co-infection, as well as of the associated mortality, in Brazil, the Americas, and worldwide. Methods: We collected data related to tuberculosis, with and without HIV co-infection, between 1990 and 2010, in Brazil, the Americas, and worldwide. Temporal trends were estimated by linear regression. Results: We identified a trend toward a decrease in tuberculosis prevalence and mortality, and that trend was more pronounced in Brazil and the Americas than worldwide. There was also a trend toward an increase in the incidence of tuberculosis/HIV co-infection, as well as in the rates of detection of new cases of active and latent tuberculosis. The incidence of tuberculosis was found to trend downward in Brazil, whereas it trended upward worldwide. Tuberculosis incidence rates correlated positively with poverty rates and with HIV incidence rates. Conclusions: Social inequality and the advent of AIDS are the major factors that aggravate the current situation of tuberculosis. In this context, methodical approaches to the assessment of surveillance activities are welcome, because they will identify situations in which the reported tuberculosis data do not reflect the true incidence of this disease.Keywords: Tuberculosis/epidemiology; HIV; Socioeconomic factors. ResumoObjetivo: Analisar a tendência temporal das taxas de prevalência, incidência e mortalidade por tuberculose, associada ou não com HIV, no Brasil, nas Américas e no mundo. Métodos: Foram coletados os dados relacionados à tuberculose, com e sem coinfecção por HIV, entre 1990 e 2010, no Brasil, nas Américas e no mundo. As tendências foram estimadas por regressão linear. Resultados: Foi identificada uma tendência de redução nas taxas de prevalência e mortalidade de tuberculose, que foi maior no Brasil e nas Américas que no mundo. Houve uma tendência crescente na incidência da coinfecção tuberculose/HIV e nas taxas de detecção de casos de tuberculose ativa e latente. Houve uma tendência de redução da incidência de tuberculose no Brasil, mas de aumento dessa no mundo. Houve uma correlação direta das taxas de incidência de tuberculose com as taxas de pobreza e as taxas de incidência de HIV. Conclusões: Desigualdades sociais e o advento da AIDS são os principais fatores que agravam a atual situação da tuberculose. Nesse contexto, abordagens metodológicas para a avaliação das ações de vigilância da tuberculose são bem-vindas, pois essas indicarão situações de dados de notificação da tuberculose que não reflitam a verdadeira incidência dessa doença.

Magnitude da tuberculose pulmonar na população fronteiriça de Mato Grosso do Sul (Brasil), Paraguai e Bolívia

“…Ações que visem ao diagnóstico precoce de HIV e à prevenção do adoecimento por tuberculose em populações pobres, com acesso limitado a serviços de saúde, não serão bem-sucedidas caso não se aplique uma abordagem integrada que busque reduzir as desigualdades sociais subjacentes 41 .…”

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

“…Thus it remains necessary to expand the screening programme to detect HIV in TB patients and vice versa, to ensure early treatment and reduce co-infection [7]. However, these strategies in themselves are not enough to reduce the level of TB-AIDS in Brazil; it is also necessary to design and implement actions to reduce social inequalities, to extend access to health services and to strengthen policies of social inclusion, taking into account that this epidemic has a major effect on the poorest groups within society [21,22].…”

Rifapentine for latent tuberculosis infection treatment in the general population and human immunodeficiency virus-positive patients: summary of evidence

“…Tuberculosis (TB) is a pronounced public health problem worldwide (1) . Unlike the active disease, latent tuberculosis infection (LTBI) is a manifestation wherein bacilli have low metabolic activity, and hence, affected patients do not show any obvious symptom or etiologic agent signs in sputum despite a positive tuberculin test (2) .…”

“…Unlike the active disease, latent tuberculosis infection (LTBI) is a manifestation wherein bacilli have low metabolic activity, and hence, affected patients do not show any obvious symptom or etiologic agent signs in sputum despite a positive tuberculin test (2) . Around one-third of the global population is currently infected by latent TB bacilli (1) (3) . Bacilli dormancy and human immunodefi ciency virus (HIV) coinfection are responsible for the persistence of TB as a public health problem (1) .…”

“…Around one-third of the global population is currently infected by latent TB bacilli (1) (3) . Bacilli dormancy and human immunodefi ciency virus (HIV) coinfection are responsible for the persistence of TB as a public health problem (1) . Hence, control measures are needed to control TB transmission and LTBI development into active disease.…”