Insufficient tuberculosis treatment leads to earlier and higher mortality in individuals co-infected with HIV in southern China: a cohort study

Zheng, Zhigang; Nehl, Eric J.; Zhou, Chu; Li, Jianjun; Xie, Zhongkui; Zhou, Zijun; Liang, Hao

doi:10.1186/s12879-020-05527-0

Cited by 10 publications

(12 citation statements)

References 23 publications

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“…[12] Despite the latest treatment outcome data showing a TB treatment success rate of 84% and antiretroviral therapy (ART) initiation rate of 88% for those with HIV-MTB co-infection in a 2015 cohort in China, [13] the mortality of those with HIV-MTB co-infection remains frustrating at 36.5% in southern China according to a recent 5-year-cohort study. [14] Various studies have reported an association between unsuccessful TB treatment and risk factors. However, inconsistent findings from previous studies have made it difficult to assess whether reported factors are applicable to the local environment.…”

Section: Yang Et Al • Medicine (2022) 101:48 Medicinementioning

confidence: 99%

Treatment outcome and its associated factors among HIV-MTB co-infected patients in Sichuan, China: A retrospective study

Yang

Chen

et al. 2022

Medicine

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Human immunodeficiency virus (HIV)-Mycobacterium tuberculosis (MTB) co-infection has become a pressing global public health problem. Although tuberculosis (TB) is both treatable and curable, it has been exacerbated by the HIV/acquired immune deficiency syndrome (AIDS) epidemic. HIV-MTB co-infected patients have a variety of disease-specific, and treatment-related factors that can adversely affect their treatment outcomes. This study was conducted to assess the outcomes of TB treatment and its associated factors among HIV-MTB co-infected patients in Sichuan, Southwest China. A retrospective study was performed on HIV-MTB co-infected patients who were diagnosed and registered in TB designated hospitals in Sichuan from January 1, 2016, to December 31, 2020. Data were collected from patients’ electronic medical records regarding their demographic, clinical, and social support information, and categorical data, such as sex, were reported using numbers and percentages. χ2 and t-tests were conducted to compare groups in relation to different levels of medical institutions. A binary logistic regression model was used to identify the factors associated with unsuccessful TB treatment outcomes. For logistic regression analysis performed using an α of 0.05, odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were calculated for various risk factors. A total of 3677 registered HIV-MTB co-infected patients were enrolled. After adjusting for other variables, male, advanced age, receiving TB treatment at the municipal medical institution, being diagnosed with external pulmonary TB, referral or tracing, being sputum smear positive, not initiating antiretroviral therapy (ART) and not using fixed-dose combinations were the main risk factors for treatment failure of HIV-MTB co-infected patients in Sichuan province. Sex, age, hospital level, patient source, other diagnostic factors (e.g., sputum smear results, anatomical site of TB), and factors of therapeutic schemes (e.g., antiretroviral therapy, fixed-dose combinations) may serve as risk factors to estimate the likely treatment outcome of HIV-TB co-infection.

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Section: Yang Et Al • Medicine (2022) 101:48 Medicinementioning

confidence: 99%

Treatment outcome and its associated factors among HIV-MTB co-infected patients in Sichuan, China: A retrospective study

Yang

Chen

et al. 2022

Medicine

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“…Findings emphasize that sufficient TB treatment should be provided, the treatment success rates should be scaled up, and efforts toward early TB case-finding among people living with HIV are essential. 8 In the third case, the patient had uncontrolled diabetes and came to the polyclinic with a neck abscess. Pus analysis confirmed the presence of AFB.…”

Section: Discussionmentioning

confidence: 99%

Tuberculous Lymphadenitis in Immunocompromised Patients: A Case Report

Wiriansya

Djaharuddin

Adam

2022

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Introduction: Tuberculous lymphadenitis (TBLN) is a form of extra-pulmonary TB with clinical features ranging from lumps to abscesses. Human Immunodeficiency Virus (HIV) co-infection and diabetes mellitus alongside TBLN made the diagnosis and management exceptionally challenging. We reported 3 cases of TBLN, 2 among them had an existing HIV co-infection, and 1 had preexisting diabetes mellitus.Case: The first case, a 28-year-old man, previously diagnosed with HIV, complained of a lump in the neck; biopsy results suggested TBLN. The second case was a 36-year-old man with a neck abscess and HIV co-infection. Acid Fast Bacilli (AFB) pus was positive & Human Immunodeficiency Virus Enzyme-Linked Immunosorbent Assay (HIV ELISA) was reactive. The third case was a patient with a neck abscess with preexisting diabetes mellitus (DM) underwent wound debridement and was given anti-tuberculosis drugs.Conclusion: TBLN with HIV co-infection or diabetes had clinical features ranging from a painful lump to an abscess. The definitive diagnosis was taken by examining AFB from pus. If the abscess was more extensive than or equal to 3 cm, wound debridement was necessary. The primary treatment for TBLN was anti-tuberculosis drugs and required even greater attention if a patient had any preexisting comorbidities such as HIV and diabetes.

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“…This feature explains the latter's seeking medical help even in acute conditions, which excludes early diagnosis of an existing disease and reduces the likelihood of successful treatment. It also suggests a lack of understanding of possible risks and low motivation in treatment, which leads to a violation of the rules for taking medications in case of their free distribution and drug resistance because of such behavior (PDR-TB) [22][23][24].…”

Section: Discussionmentioning

confidence: 99%

Medical Care for Tuberculosis-HIV-Coinfected Patients in Russia with Respect to a Changeable Patients’ Structure

et al. 2022

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To date, tuberculosis (TB) remains the primary cause of mortality in human immunodeficiency virus (HIV) patients in Russia. Since the beginning of 2000, a sharp change in the HIV patients’ structure, to the main known risk factors for HIV infection has taken place in Russia. The transmission of HIV through injectable drug use has begun to decline significantly, giving way to the prevalence of sexual HIV transmission today. These changes may require adjustments to organizational approaches to anti-TB care and the treatment of HIV-positive patients. Our study is aimed at identifying changes in TB-HIV coinfection patients’ structures in 2019 compared to 2000. Based on the results obtained, our goal was to point out the parameters that need to be taken into account when developing approaches to improve the organization of TB control care for people with HIV infection. We have carried out a cross-sectional, retrospective, epidemiological study using government TB registry data from four regions in two federal districts of Russia in 2019. The case histories of 2265 patients from two regions with high HIV prevalence, which are part of the Siberian Federal District of Russia, and 89 patient histories from two regions of low HIV prevalence, which are part of the Central Federal District of Russia, were analyzed. We found that parenteral transmission (69.4%) remains the primary route of HIV transmission among the TB-HIV coinfected. The unemployed of working age without disability account for 80.2% of all coinfected people, while the formerly incarcerated account for 53.7% and the homeless account for 4.1%. Those with primary multidrug-resistant TB (MDR-TB) comprise 56.2% of HIV-TB patients. When comparing the incidence of coinfection with HIV among TB patients, statistically significant differences were obtained. Thus, the chances of coinfection increased by 4.33 times among people with active TB (95% CI: 2.31; 8.12), by 2.97 times among people with MDR-TB (95% CI: 1.66; 5.32), by 5.2 times in people with advanced processes in the lungs, including destruction, (95% CI: 2.78; 9.7), as well as by 10.3 times in the case of death within the first year after the TB diagnosis (95% CI: 2.99; 35.5). The absence of data for the presence of TB during preventive examination was accompanied by a decrease in the chances of detecting coinfection (OR 0.36; 95% CI: 0.2; 0.64). We have identified the probable causes of the high incidence of TB among HIV-infected: HIV-patient social maladaptation usually results in delayed medical care, leading to TB treatment regimen violations. Furthermore, self-administration of drugs triggers MDR-TB within this group. Healthcare providers should clearly explain to patients the critical importance of immediately seeking medical care when initial TB symptoms appear.

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Insufficient tuberculosis treatment leads to earlier and higher mortality in individuals co-infected with HIV in southern China: a cohort study

Cited by 10 publications

References 23 publications

Treatment outcome and its associated factors among HIV-MTB co-infected patients in Sichuan, China: A retrospective study

Treatment outcome and its associated factors among HIV-MTB co-infected patients in Sichuan, China: A retrospective study

Tuberculous Lymphadenitis in Immunocompromised Patients: A Case Report

Medical Care for Tuberculosis-HIV-Coinfected Patients in Russia with Respect to a Changeable Patients’ Structure

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