Survival of people living with HIV who defaulted from TB treatment in a cohort, Recife, Brazil
Abstract
Background
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. 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.
Methods
This 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.
Results
From 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).
Conclusion
The 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.
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Source:
BMC Infectious Diseases
