Empirical treatment for TB in HIV: lessons from a cohort study of people living with HIV treated in Recife, Brazil
Empirical treatment for TB in HIV: lessons from a cohort study of people living with HIV treated in Recife, Brazil
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DOI：
10.1186/1471-2458-14-289
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发表时间：
2014-03-29
影响因子：
4.5
通讯作者：
Rodrigues, Laura C.
中科院分区：
文献类型：
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作者：
Pessoa Militao Albuquerque, Maria de Fatima;Coimbra, Isabella;Rodrigues, Laura C.
背景：结核病（TB）是全球与HIV相关的主要死亡原因。本研究分析了艾滋病毒感染者（PLHIV）的生存报告咳嗽没有细菌学确认的TB和确定因素与death.Methods：前瞻性队列连续样本的PLHIV，年龄>= 18岁。患者入选标准是在首次研究访视时或随后的常规卫生服务访视期间主诉任何持续时间的当前咳嗽，并且在整个随访期间AFB痰涂片为阴性或未进行。Kaplan-Meier法计算生存概率。我们估计的风险比（HR）在双变量和多变量考克斯回归analysis.Results：死亡率为4.6每100 py，73%的人在招聘接受HAART。从第一次记录咳嗽日期到肺结核经验性治疗的平均时间为6个月。当CD 4计数较低（HR = 5.3; CI 95%：3.2-9.0; p = 0.000）、贫血（HR = 3.0; CI 95%：1.6-5.6; p = 0.001）和胸部X线检查异常（HR = 2.4; CI 95%：1.4-4.0; p = 0.001）时，死亡率较高。接受经验性结核病治疗的患者死亡率较高（HR = 2.4; CI 95%：1.4-4.0; p = 0.002），但仅限于X线检查正常、无结核病史和无细菌学要求的患者。在CD 4细胞计数低、贫血、机会性感染史、体重减轻、既往结核病史、细菌学检测阴性（而不是没有检测）和胸部X线检查异常的PLHIV中，结核病的经验性治疗更常见。结论：CD 4细胞计数高的PLHIV报告当前咳嗽而没有细菌学确诊结核病的死亡率较高
Background: Tuberculosis (TB) is the leading cause of death related to HIV worldwide. This study analyzes the survival of People Living with HIV (PLHIV) reporting cough without bacteriological confirmation of TB and identify factors associated with death.Methods: Prospective cohort with a consecutive sample of PLHIV, aged >= 18 years. Patient inclusion criteria were complaint of current cough of any duration at the time of the first study interview or during their subsequent routine visits to health services and for whom AFB sputum smear was either negative or not performed during the whole follow-up period. Kaplan-Meier method was used to calculate the probability of survival. We estimated the Hazard Ratio (HR) in bivariate and multivariate Cox regression analyses.Results: Mortality was 4.6 per 100 py; 73% were receiving HAART at recruitment. Average time from the first recorded date of cough until empirical treatment for tuberculosis was six months. Mortality was higher when the CD4 count was low (HR = 5.3; CI 95%: 3.2-9.0; p = 0.000), in those with anemia (HR = 3.0; CI 95%: 1.6-5.6; p = 0.001) and with abnormal chest X-rays (HR = 2.4; CI 95%: 1.4-4.0; p = 0.001). Mortality was higher in those receiving empirical TB treatment (HR = 2.4; CI 95%: 1.4-4.0; p = 0.002), but only in those with normal X-rays, no history of tuberculosis and no bacteriology requests. Empirical treatment for TB was more frequent in PLHIV with low CD4 counts, anemia, history of opportunistic infections, weight loss, previous tuberculosis, negative bacteriology test (as opposed to not having a test) and abnormal chest X-ray.Conclusions: Higher mortality in PLHIV reporting a current cough without bacteriological confirmation of tuberculosis was identified for those with a CD4 cell count