Villalva-Serra Klauss, Barreto-Duarte Beatriz, Nunes Vanessa M, Menezes Rodrigo C, Rodrigues Moreno M S, Queiroz Artur T L, Arriaga María B, Cordeiro-Santos Marcelo, Kritski Afrânio L, Sterling Timothy R, Araújo-Pereira Mariana, Andrade Bruno B
Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil.
Curso de Medicina, Universidade Salvador (UNIFACS), Salvador, Brazil.
Front Med (Lausanne). 2022 Sep 16;9:972145. doi: 10.3389/fmed.2022.972145. eCollection 2022.
Tuberculosis (TB) is a worldwide public health problem, especially in countries that also report high numbers of people living with HIV (PLWH) and/or diabetes mellitus (DM). However, the unique features of persons with TB-HIV-DM are incompletely understood. This study compared anti-TB treatment (ATT) outcomes of diabetic and non-diabetic TB/HIV co-infected patients.
A nationwide retrospective observational investigation was performed with data from the Brazilian Tuberculosis Database System among patients reported to have TB-HIV co-infection between 2014 and 2019. This database includes all reported TB cases in Brazil. Exploratory and association analyses compared TB treatment outcomes in DM and non-DM patients. Unfavorable outcomes were defined as death, treatment failure, loss to follow-up or recurrence. Multivariable stepwise logistic regressions were used to identify the variables associated with unfavorable ATT outcomes in the TB-HIV population.
Of the 31,070 TB-HIV patients analyzed, 999 (3.2%) reported having DM. However, in these TB-HIV patients, DM was not associated with any unfavorable treatment outcome [adjusted Odds Ratio (aOR): 0.97, 95% CI: 0.83-1.12, = 0.781]. Furthermore, DM was also not associated with any specific type of unfavorable outcome in this study. In both the TB-HIV group and the TB-HIV-DM subpopulation, use of alcohol, illicit drugs and tobacco, as well as non-white ethnicity and prior TB were all characteristics more frequently observed in persons who experienced an unfavorable ATT outcome.
DM is not associated with unfavorable TB treatment outcomes in persons with TB-HIV, including death, treatment failure, recurrence and loss to follow up. However, consumption habits, non-white ethnicity and prior TB are all more frequently detected in those with unfavorable outcomes in both TB-HIV and TB-HIV-DM patients.
结核病是一个全球性的公共卫生问题，在报告有大量艾滋病毒感染者（PLWH）和/或糖尿病患者（DM）的国家尤为如此。然而，结核病合并艾滋病毒和糖尿病患者的独特特征尚未完全明确。本研究比较了糖尿病和非糖尿病结核病/艾滋病毒合并感染患者的抗结核治疗（ATT）结果。
利用巴西结核病数据库系统的数据，对2014年至2019年间报告的结核病合并艾滋病毒感染患者进行了一项全国性回顾性观察研究。该数据库包括巴西所有报告的结核病病例。探索性和关联性分析比较了糖尿病和非糖尿病患者的结核病治疗结果。不良结果定义为死亡、治疗失败、失访或复发。采用多变量逐步逻辑回归分析来确定与结核病合并艾滋病毒人群抗结核治疗不良结果相关的变量。
在分析的31070例结核病合并艾滋病毒患者中，999例（3.2%）报告患有糖尿病。然而，在这些结核病合并艾滋病毒患者中，糖尿病与任何不良治疗结果均无关联[调整后的优势比（aOR）：0.97，95%置信区间：0.83 - 1.12，P = 0.781]。此外，在本研究中，糖尿病也与任何特定类型的不良结果无关。在结核病合并艾滋病毒组和结核病合并艾滋病毒与糖尿病亚组中，饮酒、使用非法药物和烟草，以及非白人种族和既往结核病都是在抗结核治疗结果不良的患者中更常观察到的特征。
糖尿病与结核病合并艾滋病毒患者的不良结核病治疗结果无关，包括死亡、治疗失败、复发和失访。然而，在结核病合并艾滋病毒和结核病合并艾滋病毒与糖尿病患者中，不良结果患者的消费习惯、非白人种族和既往结核病更为常见。
