Treatment outcome and laboratory confirmation of tuberculosis diagnosis in patients with HIV/AIDS in Recife, Brazil
Treatment outcome and laboratory confirmation of tuberculosis diagnosis in patients with HIV/AIDS in Recife, Brazil
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DOI：
10.1590/s1806-37132008000600010
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发表时间：
2008-06-01
影响因子：
2.7
通讯作者：
Lacerda, Heloísa Ramos
中科院分区：
文献类型：
--
作者：
Maruza, Magda;Ximenes, Ricardo Arraes de Alencar;Lacerda, Heloísa Ramos
目的：比较实验室确诊后接受结核病治疗的结核病/HIV混合感染者和未经诊断确认而接受治疗的结核病/HIV混合感染者的不良结局(死亡或缺席和治疗失败)的频率。方法：对2002年7月至2004年6月在巴西累西腓一家HIV/AIDS转诊中心开始治疗的结核病/HIV混合感染者进行回顾性队列研究。主要暴露变量--实验室确认结核病--根据三组不同变量进行了调整：社会人口学变量；艾滋病毒/艾滋病相关变量；以及结核病相关变量。为了评估结果的统计学意义，我们计算了95%可信区间的优势比和p值(来自卡方检验和似然比检验)。结果：总共有262名患者参加了研究。即使在调整了混杂因素后，也没有发现在治疗开始时实验室确认诊断为结核病与不良结果之间存在关联。在最终的多元Logistic回归模型中，以下变量仍然存在：其他机会性疾病的存在；CD4淋巴细胞计数低于50细胞/毫米(3)；病毒载量在10,000至100,000拷贝/毫升之间；呼吸困难；结核病的播散性形式；以及因不良反应或耐受性而改变结核病治疗方案。结论：我们的结果表明，在没有结核病病因确认的情况下，由转诊中心有经验的医生判断，结核病治疗不会增加不良结果的风险。此外，它还允许确定由于出现不利结果的风险较大而应密切监测的群体。
OBJECTIVE: To compare the frequency of unfavorable outcome (death or default and treatment failure) between tuberculosis (TB)/HIV co-infected patients treated for TB after laboratory confirmation of the diagnosis and TB/HIV co-infected patients who were so treated without diagnostic confirmation.METHODS: A retrospective cohort of TB/HIV co-infected patients who started TB treatment between July of 2002 and June of 2004 at an HIV/AIDS referral center in Recife, Brazil. The main exposure variable, laboratory confirmation of TB, was adjusted for three different sets of variables: sociodemographic variables; HIV/AIDS-related variables; and TB-related variables. In order to evaluate the statistical significance of the results, we calculated odds ratios, with 95% confidence intervals, and p values (from chi-square tests and likelihood ratio tests).RESULTS: A total of 262 patients were studied. No association was found between laboratory confirmation of the diagnosis of TB at treatment outset and unfavorable outcome, even after adjustment for confounders. In the final multiple logistic regression model, the following variables remained: the presence of other opportunistic diseases; CD4 lymphocyte count below 50 cells/mm(3); viral load between 10,000 and 100,000 copies/mL; dyspnea; the disseminated form of TB; and change in the TB treatment regimen due to adverse reactions or intolerance.CONCLUSIONS: Our results suggest that TB treatment in TB/HIV co-infected patients without etiologic confirmation of TB, at the discretion of experienced physicians in referral centers, did not increase the risk of unfavorable outcomes. In addition, it allowed the identification of groups that should be closely monitored due to a greater risk of unfavorable outcomes.