Incidence and Risk Factors for Tuberculosis in People Living with HIV: Cohort from HIV Referral Health Centers in Recife, Brazil

Abstract

ObjectiveTo identify the incidence of and risk factors for tuberculosis in people living with HIV (PLHIV).DesignObservational, prospective cohort study.MethodsA total of 2069 HIV-infected patients was observed between July 2007 and December 2010. The Kaplan-Meier method was used to estimate the probability of survival free of tuberculosis, and Cox regression analysis to identify risk factors associated with the development of tuberculosis.ResultsSurvival free of tuberculosis (TB) was 91%. The incidence rate of tuberculosis was 2.8 per 100 persons/years. Incidence of tuberculosis was higher when subjects had CD4 cell count <200 cells/mm3; were not on antiretroviral therapy; in those who had, a body mass index <18.5 kg/m2, anemia (or were not tested for it), were illiterate or referred previous tuberculosis treatment at entry into the cohort. Those not treated for latent TB infection had a much higher risk (HR = 7.9) of tuberculosis than those with a negative tuberculin skin test (TST). Having a TST≥5 mm but not being treated for latent TB infection increased the risk of incident tuberculosis even in those with a history of previous tuberculosis.ConclusionsPreventive actions to reduce the risk of TB in people living with HIV should include an appropriate HAART and treatment for latent TB infection in those with TST≥5 mm. The actions towards enabling rigorous implementation of treatment of latent TB infection and targeting of PLHIV drug users both at the individual and in public health level can reduce substantially the incidence of TB in PLHIV.

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

“…The magnitude of the association between the selected explanatory variables and the death event was estimated by the adjusted hazard ratio (AHR) with 95% confidence interval (CI), which was obtained using the Cox proportional There was a clear predominance of male patients in this study, which agrees with the findings other studies in the Brazilian context that observed a higher incidence and prevalence of TB/HIV among male patients. 5,21 In addition, our findings showed a prevalence of coinfection among individuals aged 20-59 years, which is similar to the results of other studies. 22 Currently, the increase in the number of individuals with HIV infection, aged over 50 years, both in Brazil and in the world, can be detected and evaluated on the basis of demographic data, increase in the number of notifications and aging of the infected population.…”

Increasing incidence of HIV‐ associated tuberculosis in Romanian injecting drug users

“…It has been previously shown that PLWH with lower CD4 counts are more likely to develop TB compared with people with better immune status at HIV diagnosis . Similar to data reported annually from European Centre for Disease Prevention and Control (ECDC) , we found pulmonary TB to be the most frequent clinical form of disease.…”

Sobrevida de pacientes com AIDS e coinfecção pelo bacilo da tuberculose nas regiões Sul e Sudeste do Brasil

“…Cases of AIDS with or without TB diagnosis are more prevalent among males, as seen in other studies [1][2][3]19 . The strong relation with poverty, low schooling and TB may explain the greater risk of dying among individuals up to four years of is significant at the 0.05 level.…”

“…There are, in Brazil, great differences in TB incidence and mortality, particularly higher in regions with greater prevalence of HIV infections 18,19 . Besides, AIDS-Tuberculosis co-infection is identified as an associated factor in TB internment cases 20 .…”