da Silva Escada Rodrigo Otavio, Velasque Luciane, Ribeiro Sayonara Rocha, Cardoso Sandra Wagner, Marins Luana Monteiro Spindola, Grinsztejn Eduarda, da Silva Lourenço Maria Cristina, Grinsztejn Beatriz, Veloso Valdiléa Gonçalves
Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
Departamento de Matemática e Estatística, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.
BMC Infect Dis. 2017 May 30;17(1):373. doi: 10.1186/s12879-017-2473-y.
Tuberculosis is the most frequent opportunistic infection and the leading cause of death among persons living with HIV in several low and middle-income countries. Mortality rates during tuberculosis treatment and death causes among HIV-1/TB co-infected patients may differ based on the immunosuppression severity, timing of diagnosis and prompt initiation of tuberculosis and antiretroviral therapy.
This was a retrospective observational study conducted in the clinical cohort of patients with HIV-1/Aids of the National Institute of Infectious Diseases Evandro Chagas, Rio de Janeiro, Brazil. All HIV-1 infected patients who started combination antiretroviral therapy up to 30 days before or within 180 days after the start of tuberculosis treatment from 2000 to 2010 were eligible. Causes of death were categorized according to the "Coding Causes of Death in HIV" (CoDe) protocol. The Cox model was used to estimate the hazard ratio (HR) of selected mortality variables.
A total of 310 patients were included. Sixty-four patients died during the study period. Mortality rate following tuberculosis treatment initiation was 44 per 100 person-years within the first 30 days, 28.1 per 100 person-years within 31 and 90 days, 6 per 100 person-years within 91 and 365 days and 1.6 per 100 person-years after 365 days. Death probability within one year from tuberculosis treatment initiation was approximately 13%. In the adjusted analysis the associated factors with mortality were: CD4 ≤ 50 cells/mm3 (HR: 3.10; 95% CI: 1.720 to 5.580; p = 0.00); mechanical ventilation (HR: 2.81; 95% CI: 1.170 to 6.760; p = 0.02); and disseminated tuberculosis (HR: 3.70; 95% CI: 1.290 to 10.590, p = 0.01). Invasive bacterial disease was the main immediate cause of death (46.9%).
Our results evidence the high morbidity and mortality among patients co-infected with HIV-1 and tuberculosis in Rio de Janeiro, Brazil. During the first year following tuberculosis diagnosis, mortality was the highest within the first 3 months, being invasive bacterial infection the major cause of death. In order to successfully intervene in this scenario, it is utterly necessary to address the social determinants of health contributing to the inequitable health care access faced by this population.
在一些低收入和中等收入国家，结核病是最常见的机会性感染，也是艾滋病毒感染者的主要死因。艾滋病毒-1/结核病合并感染患者在结核病治疗期间的死亡率及死亡原因可能因免疫抑制严重程度、诊断时间以及结核病和抗逆转录病毒疗法的及时启动情况而有所不同。
这是一项在巴西里约热内卢埃万德罗·查加斯国家传染病研究所的艾滋病毒-1/艾滋病临床队列中进行的回顾性观察研究。纳入2000年至2010年期间在开始结核病治疗前30天内或开始结核病治疗后180天内开始接受联合抗逆转录病毒治疗的所有艾滋病毒-1感染患者。根据“艾滋病毒死亡原因编码”（CoDe）方案对死亡原因进行分类。采用Cox模型估计选定死亡变量的风险比（HR）。
共纳入310例患者。研究期间64例患者死亡。开始结核病治疗后的死亡率在前30天内为每100人年44例，31至90天内为每100人年28.1例，91至365天内为每100人年6例，365天后为每100人年1.6例。开始结核病治疗后一年内的死亡概率约为13%。在多因素分析中，与死亡率相关的因素为：CD4≤50个细胞/mm³（HR：3.10；95%CI：1.720至5.580；p=0.00）；机械通气（HR：2.81；95%CI：1.170至6.760；p=0.02）；播散性结核病（HR：3.70；95%CI：1.290至10.590，p=0.01）。侵袭性细菌疾病是主要的直接死亡原因（46.9%）。
我们的结果证明巴西里约热内卢艾滋病毒-1和结核病合并感染患者的发病率和死亡率很高。在结核病诊断后的第一年，前3个月内死亡率最高，侵袭性细菌感染是主要死亡原因。为了在这种情况下成功进行干预，必须解决导致该人群面临不公平医疗服务获取的健康社会决定因素。
