Six-month survival of critically ill patients with HIV-related disease and tuberculosis: a retrospective study

Abstract

BackgroundTuberculosis is one of the leading causes of death from infectious diseases worldwide, mainly after the human immunodeficiency virus (HIV) epidemics. Patient with HIV-related illness are more likely to present with severe TB due to immunosuppression. Very few studies have explored HIV/TB co-infection in critically ill patients. The goal of this study was to analyze factors associated with long-term mortality in critically ill patient with HIV-related disease coinfected with TB.MethodsWe conducted a retrospective study in an infectious disease reference center in Brazil that included all patient with HIV-related illness admitted to the ICU with laboratory-confirmed tuberculosis from March 2007 until June 2012. Clinical and laboratory variables were analyzed based on six-month survival.ResultsForty-four patients with HIV-related illness with a confirmed diagnosis of tuberculosis were analyzed. The six-month mortality was 52 % (23 patients). The main causes of admission were respiratory failure (41 %), severe sepsis/septic shock (32 %) and coma/torpor (14 %). The median time between HIV diagnosis and ICU admission was 5 (1–60) months, and 41 % of patients received their HIV infection diagnosis ≤ 30 days before admission. The median CD4 count was 72 (IQR: 23–136) cells/mm3. The clinical presentation was pulmonary tuberculosis in 22 patients (50 %) and disseminated TB in 20 patients (45.5 %). No aspect of TB diagnosis or treatment was different between survivors and nonsurvivors. Neurological dysfunction was more prevalent among nonsurvivors (43 % vs. 14 %, p = 0.04). The nadir CD4 cell count lower than 50 cells/mm3 was independently associated with Six-month mortality (hazard ratio 4.58 [1.64–12.74], p < 0.01), while HIV diagnosis less than three months after positive serology was protective (hazard ratio 0.27, CI 95 % [0.10–0.72], p = 0.01).ConclusionThe Six-month mortality of HIV critically ill patients with TB coinfection is high and strongly associated with the nadir CD4 cell count less than 50 cels/mm3.

Prevalence of Hiv/Tb Coinfection in Patients from a Referral Hospital in Rio de Janeiro City / Prevalência da Coinfecção Hiv/Tb em Pacientes de um Hospital de Referência na Cidade do Rio De Janeiro

“…Tuberculosis is one of the leading causes of death from infectious diseases worldwide, especially after the HIV epidemic event. 10 In this study, 40 cases of MDR-TB were diagnosed during the study period. With monoresistance pattern of (35%), and multiresistance pattern of 65%.…”

Needs of the Relatives of Patients Hospitalized in an Intensive Therapy Unit / Necessidades de Familiares de Pacientes Internados em Unidade de Terapia Intensiva

“…A study carried out in São Paulo city, Brazil, with 39 relatives of patients showed that having the patient's information, waiting for news related to an improvement in the clinical state, an increase in the probability of cure or a reduction in the risk of death, are generally the "good news" by family members. 10 Thus, the moment of the visit is the most awaited moment for them, who long to withdraw their doubts, minimize their uncertainties and, above all, receive positive news regarding the patient.…”

“…9 The CCFNI consists of 43 items, organized into four areas of need, namely: 1) need for knowledge/information; 2) comfort; 3) emotional security; and 4) need for access to the patient and the unit's professionals. 10 The answers are presented on a Likert scale of four points: (1) not important, (2) less important, (3) very important and (4) extremely important. The higher the value assigned to the item, the greater the degree of importance to the need in question.…”

Os determinantes da mortalidade por Tuberculose e TB-HIV no Sul do Brasil: Da abordagem espacial à análise de sobrevida

“…A diferença de sobrevida entre indivíduos com TB e TB/HIV não apresentou significância estatística, embora a mediana entre o grupo com a coinfecção tenha sido maior, ou seja, estes sobreviveram mais dias do que o grupo com apenas TB; uma questão que pode justificar este resultado é o fato que pessoas vivendo com HIV/Aids recebem acompanhamento de saúde contínuo de equipe multiprofissional, com consultas, exames e dispensação dos medicamentos periodicamente, o que leva a um contato intermitente com os profissionais de saúde e aumenta as oportunidades de reconhecimento de sinais e sintomas da TB, o que é inclusive recomendado nos protocolos de manejo destes pacientes: a investigação da TB em toda consulta (BRASIL 2013). Outros estudos encontram que a coinfecção com HIV esteve associada a mortes precoces por TB (CECCON et al, 2017;GESESEW et al, 2016;GAIFER et al, 2016;PECEGO et al, 2016).…”

“…Alguns estudos (OLIVEIRA et al, 2019;FERREIRA et al, 2018;LEE et al, 2017;PECEGO et al, 2016;BIGNA et al, 2015;FIELD et al, 2014) investigaram as mortes precoces por TB e fatores associados e, dentre aqueles identificados, encontraram a presença de comorbidades como HIV (CECCON et al, 2017;GESESEW et al, 2016;GAIFER et al, 2016;PECEGO et al, 2016;FIELD et al, 2014 ), doenças do aparelho respiratório, derrame pleural (OLIVEIRA et al, 2019;YEN et al, 2017)…”