Abstract
BackgroundThe delay in initiating treatment for tuberculosis (TB) in HIV-infected individuals may lead to the development of a more severe form of the disease, with higher rates of morbidity, mortality and transmissibility. The aim of the present study was to estimate the time interval between the onset of symptoms and initiating treatment for TB in HIV-infected individuals, and to identify the factors associated to this delay.MethodsA nested case-control study was undertaken within a cohort of HIV-infected individuals, attended at two HIV referral centers, in the state of Pernambuco, Brazil. Delay in initiating treatment for TB was defined as the period of time, in days, which was greater than the median value between the onset of cough and initiating treatment for TB. The study analyzed biological, clinical, socioeconomic, and lifestyle factors as well as those related to HIV and TB infection, potentially associated to delay. The odds ratios were estimated with the respective confidence intervals and p-values.ResultsFrom a cohort of 2365 HIV-infected adults, 274 presented pulmonary TB and of these, 242 participated in the study. Patients were already attending 2 health services at the time they developed a cough (period range: 1 – 552 days), with a median value of 41 days. Factors associated to delay were: systemic symptoms asthenia, chest pain, use of illicit drugs and sputum smear-negative.ConclusionThe present study indirectly showed the difficulty of diagnosing TB in HIV-infected individuals and indicated the need for a better assessment of asthenia and chest pain as factors that may be present in co-infected patients. It is also necessary to discuss the role played by negative sputum smear results in diagnosing TB/HIV co-infection as well as the need to assess the best approach for drug users with TB/HIV.
Highlights
The delay in initiating treatment for tuberculosis (TB) in HIV-infected individuals may lead to the development of a more severe form of the disease, with higher rates of morbidity, mortality and transmissibility
Study design and population A nested case-control study was undertaken within a cohort of HIV-infected individuals, aged 18 years and Definition of terms and variables Cases of active pulmonary TB were those for whom TB treatment had been initiated by an attending physician through laboratory confirmation by sputum smear and/or sputum culture or clinical suspicion
The present study considers that in order to reduce the delay in starting TB treatment in individuals living with HIV, patient surveillance needs to be constant, regardless of the number of potentially TB-associated symptoms, and should be conducted by all health professionals who provide care for HIV-infected patients
Summary
The delay in initiating treatment for tuberculosis (TB) in HIV-infected individuals may lead to the development of a more severe form of the disease, with higher rates of morbidity, mortality and transmissibility. In HIV-infected individuals, delay in initiating treatment for TB is an important factor for high morbidity [5], mortality [1] and transmissibility of the disease [6,7], and may result in the prolonged occupation of hospital beds, both in developing countries and in industrialized countries [8]. One further problem is that a high degree of immunodeficiency may modify the clinical and radiological features of TB [10], making diagnosis even more difficult and may lead to death before TB treatment has been initiated [11]
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