de Resende Natália Helena, de Miranda Silvana Spíndola, Reis Adriano Max Moreira, de Pádua Cristiane Aparecida Menezes, Haddad João Paulo Amaral, da Silva Paulo Vitor Rozario, da Silva Dirce Inês, Carvalho Wânia da Silva
College of Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil.
College of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, Brazil.
Diagnostics (Basel). 2023 Mar 20;13(6):1181. doi: 10.3390/diagnostics13061181.
(1) Background: Infection with the Human Immunodeficiency Virus (HIV) is a significant challenge for tuberculosis (TB) control, with increasing mortality rates worldwide. Moreover, the loss to follow-up is very high, with low adherence to treatment, resulting in unfavorable endpoints. This study aimed to analyze the effectiveness of TB treatment in patients coinfected with HIV/AIDS and its associated factors. (2) Methods: Patients coinfected with TB and HIV/AIDS at a Reference Hospital for infectious diseases were followed up for a maximum of one year from the start of TB treatment until cure or censorship (death, abandonment, and transfer) from 2015 to 2019. The Cox proportional model was used to identify risk factors for effectiveness. (3) Results: Of the 244 patients included in the cohort, 58.2% (142/244) had no treatment effectiveness, 12.3% (30/244) died, and 11.1% (27/244) abandoned treatment. Viral suppression at the onset of TB treatment (HR = 1.961, CI = 1.123-3.422), previous use of Antiretroviral Therapy (HR = 1.676, CI = 1.060-2.651), new cases (HR = 2.407, CI = 1.197-3.501), not using illicit drugs (HR = 1.763, CI = 1.141-2.723), and using the basic TB regimen (HR = 1.864, CI = 1.084-3.205) were significant variables per the multivariate Cox regression analysis. (4) Conclusion: TB treatment for most TB patients coinfected with HIV/AIDS was not effective. This study identified that an undetectable viral load at the beginning of the disease, previous use of ART, not using illicit drugs and not having previously taken anti-TB treatment are factors associated with successful TB treatment.
(1) 背景：感染人类免疫缺陷病毒（HIV）对结核病（TB）控制而言是一项重大挑战，全球死亡率不断上升。此外，失访率极高，治疗依从性低，导致不良结局。本研究旨在分析HIV/AIDS合并感染患者的结核病治疗效果及其相关因素。(2) 方法：2015年至2019年期间，对一家传染病参考医院中结核病与HIV/AIDS合并感染的患者从结核病治疗开始起进行了最长一年的随访，直至治愈或失访（死亡、放弃治疗和转院）。采用Cox比例模型确定治疗效果的危险因素。(3) 结果：该队列纳入的244例患者中，58.2%（142/244）治疗无效，12.3%（30/244）死亡，11.1%（27/244）放弃治疗由多变量Cox回归分析可知，结核病治疗开始时的病毒抑制（HR = 1.961，CI = 1.123 - 3.422）、既往使用抗逆转录病毒疗法（HR = 1.676，CI = 1.060 - 2.651）、新发病例（HR = 2.407，CI = 1.197 - 3.501）、不使用非法药物（HR = 1.763，CI = 1.141 - 2.723）以及使用基本结核病治疗方案（HR = 1.864，CI = 1.084 - 3.205）均为显著变量。(4) 结论：大多数HIV/AIDS合并感染的结核病患者的结核病治疗无效。本研究确定，疾病开始时病毒载量不可检测、既往使用抗逆转录病毒治疗、不使用非法药物以及既往未接受过抗结核治疗是与结核病治疗成功相关的因素。
