Tuberculosis in a cohort of HIV-positive patients: epidemiology, clinical practice and treatment outcomes
To describe tuberculosis (TB) incidence, risk factors, clinical presentation, disease management and outcomes in human immunodeficiency virus (HIV) infected patients from the CoRIS cohort, Spain, 2004–2010.
Open multicentre cohort of antiretroviral treatment (ART) naïve patients at entry. Incidence and risk factors were evaluated using multivariate Poisson regression.
Among 6811 patients, 271 were eligible for the study and 198 for the estimation of the incidence rate; TB incidence ranged from 12.1 to 14.1/1000 person-years. TB was associated with low education level (rate ratio [RR] 2.65, 95%CI 1.73–4.07), being sub-Saharan African (RR 3.14, 95%CI 1.81–5.45), heterosexual (RR 2.01, 95%CI 1.22–3.29) or an injecting drug user (RR 2.11, 95%CI 1.20–3.69), not undergoing ART (RR 3.33, 95%CI 2.22–4.76), CD4 <200 cells/mm3 (RR 5.20, 95%CI 3.25–8.33) and log-viral load of 4–5 (RR 5.44, 95%CI 3.28–9.02) or >5 (RR 13.10, 95%CI 8.27–20.76). Overall, 87% were new cases and 13% were previously treated cases; 175 (65%) were bacteriologically confirmed. Drug susceptibility testing was performed in 146 (83%) patients: resistance to first-line drugs was 11.1% in new and 36.4% in previously treated cases. Standard anti-tuberculosis treatment with four or three drugs was prescribed in respectively 55% and 36% of cases. Treatment default was 11%, and was higher among previously treated cases; 80% received ART during anti-tuberculosis treatment, 80% of new and 50% of previously treated cases were cured or completed treatment, and 18 (6.6%) died.
TB incidence in HIV-infected patients remains high. Interventions should include early HIV diagnosis and access to ART, enhanced bacteriological confirmation, wider use of four-drug regimens and reduction in treatment default.
Document Type: Research Article
Affiliations: 1: Red de Investigación en Sida, Centro Nacional de Epidemiología, CIBER de Epidemiología y Salud Pública (CIBERESP), Spain 2: Aacute;rea de Vigilancia Epidemiológica del VIH/SIDA y Comportamientos de Riesgo, Plan Nacional sobre el SIDA, Ministerio de Sanidad, Servicios Sociales e Igualdad/Centro Nacional de Epidemiología, Instituto de Salud Carlos III and CIBERESP Madrid, Spain 3: Hospital Universitario 12 de Octubre, Madrid, Spain 4: Hospital Universitario de Donostia, San Sebastián, Spain 5: Hospital Universitari Son Espases, Palma de Mallorca, Spain 6: Hospital Universitario Miguel Servet, Zaragoza, Spain 7: El Hospital Universitari i Politècnic La Fe, Valencia, Spain 8: Hospital Clinic Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain 9: Hospital Universitario Ramón y Cajal, Madrid, Spain
Publication date: June 1, 2014
The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.
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