Abstract
BackgroundTuberculosis is a serious public health problem worldwide. It is the leading cause of death amongst people living with HIV, and default from tuberculosis (TB) treatment in people living with HIV increases the probability of death. The aim of this study was to estimate the survival probability of people living with HIV who default treatment for TB compared to those who complete the treatment.MethodsThis was a longitudinal cohort study of people living with HIV, from June 2007 to December 2013 with two components: a retrospective (for those who started tuberculosis treatment before 2013 for whom failure (death) or censoring occurred before 2013), and prospective (those who started tuberculosis treatment at any time between 2007 and June 2013 and for whom death or censoring occurred after the beginning of 2013), at two referral hospitals for people living with HIV (Correia Picanço Hospital - HCP and at Hospital Universitário Oswaldo Cruz – HUOC), in Recife/PE. A total of 317 patients who initiated TB treatment were studied. Default from TB treatment was defined as any patient who failed to attend their pre-booked return appointment at the health center for more than 30 consecutive days, in accordance with Brazilian Ministry of Health recommendations.ResultsFrom a cohort of 2372 people living with HIV we analyzed 317 patients who had initiated TB treatment. The incidence of death was 5.6 deaths per 100 persons per year (CI 95% 4.5 to 7.08). Independent factors associated with death: default from TB treatment 3.65 HR (95% CI 2.28 to 5.83); CD4 < 200 cells/mm3 2.39 HR (95% CI 1.44 to 3.96); extrapulmonary tuberculosis 1.56 HR (95% CI 0.93 to 2.63); smoking 2.28 HR (95% CI 1.33 to 3.89); alcohol light 0.13 HR (95% CI 0.03 to 0.56).ConclusionThe probability of death in people living with HIV who default TB treatment is approximately four times greater when compared to those who do not default from treatment.
Highlights
Tuberculosis is a serious public health problem worldwide
Some authors found an association between defaulting from TB treatment and male sex, smoking, lymphocyte Count linfocits T CD4 (CD4) count
In the group that did not default treatment, 38.9% of the deaths occurred within two years of initiating treatment for TB, while the percentages of death for those who defaulted treatment in the first and second quarter were, respectively, 70% and 57.9%. (Table 2) The death rate amongst patients who defaulted TB treatment was 14.4 deaths per 100 person/years and among patients who did not default treatment 3.4 deaths per 100 person/years (Fig. 2)
Summary
Tuberculosis is a serious public health problem worldwide It is the leading cause of death amongst people living with HIV, and default from tuberculosis (TB) treatment in people living with HIV increases the probability of death. Default from treatment features amongst the leading causes of TB treatment failure in people living with HIV, and may be associated with a higher mortality rate within this group [7, 15, 19] This aim of this study was to compare the survival probability of people living with HIV who defaulted treatment for TB with those who did not default treatment
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