Teixeira Francine, Raboni Sonia M, Ribeiro Clea El, França João Cb, Broska Anne C, Souza Nathalia Ls
Post-Graduate Program in Internal Medicine and Health Science, Universidade Federal do Paraná, Curitiba, Brazil.
Infectious Diseases Division, Universidade Federal do Paraná, Curitiba, Brazil.
Microbiol Insights. 2018 Nov 27;11:1178636118813367. doi: 10.1177/1178636118813367. eCollection 2018.
Worldwide, the convergence of tuberculosis (TB) and human immunodeficiency virus type 1 (HIV-1) infection epidemics is a public health challenge. In Brazil, TB is the leading cause of death by infectious disease in people living with HIV (PLWH). This study aimed to report the clinical, demographic, epidemiological, and laboratory data for TB in PLWH. This cross-sectional study involved a retrospective analysis of data for patients with TB/HIV coinfection who attended from 2006 to 2015 through a review of medical records. A total of 182 patients were identified, of whom 12 were excluded. Patients were divided according to whether they had pulmonary tuberculosis (PTB; n = 48; 28%) or extrapulmonary tuberculosis (EPTB; n = 122; 72%). The diagnosis was laboratory confirmed in 75% of PTB patients and 78.7% of EPTB patients. The overall 1-year mortality rate was 37.6%, being 22.9% in PTB patients and 69% in EPTB patients; 84% of these deaths were TB-related. The CD4+ count and disseminated TB were independent risk factors for death. The frequency of resistance among (MTB) isolates was 14%. TB in PLWH is associated with high morbidity and mortality, and severe immunosuppression is a risk factor for death. Appropriate measures for early TB detection should reduce the case fatality rate in high-burden settings.
在全球范围内，结核病（TB）与1型人类免疫缺陷病毒（HIV-1）感染流行的交汇是一项公共卫生挑战。在巴西，结核病是艾滋病毒感染者（PLWH）中因传染病导致死亡的主要原因。本研究旨在报告PLWH中结核病的临床、人口统计学、流行病学和实验室数据。这项横断面研究通过回顾病历对2006年至2015年就诊的结核/艾滋病毒合并感染患者的数据进行了回顾性分析。共确定了182例患者，其中12例被排除。患者根据是否患有肺结核（PTB；n = 48；28%）或肺外结核（EPTB；n = 122；72%）进行分组。75%的PTB患者和78.7%的EPTB患者经实验室确诊。总体1年死亡率为37.6%，PTB患者为22.9%，EPTB患者为69%；这些死亡中有84%与结核病相关。CD4 + 细胞计数和播散性结核病是死亡的独立危险因素。结核分枝杆菌（MTB）分离株中的耐药频率为14%。PLWH中的结核病与高发病率和死亡率相关，严重免疫抑制是死亡的危险因素。在高负担环境中，早期结核病检测的适当措施应能降低病死率。
