Associated factors for treatment delay in pulmonary tuberculosis in HIV-infected individuals: a nested case-control study

BMC Infectious Diseases

Ricardo Arraes de Alencar Ximenes³  Laura Cunha Rodrigues⁴  Heloísa Ramos Lacerda³  Demócrito de Barros Miranda-Filho¹  George Tadeu Nunes Diniz²  Líbia Vilela Moura³  Maria de Fátima Pessoa Militão-Albuquerque²  Magda Maruza³  Isabella Coimbra³ 

[1] Department of Clinical Medicine, Universidade de Pernambuco, Recife, Pernambuco, Brazil;The Ageu Magalhães Research Center, FIOCRUZ, Recife, Pernambuco, Brazil;Post-graduation program in Tropical Medicine, Universidade Federal de Pernambuco, Rua Antonio Rabelo 245, Madalena, Recife, PE, CEP 50610-110, Brazil;London School of Hygiene and Tropical Medicine, London, UK

关键词: Delay;    Tuberculosis;    HIV;   

Others  :  1159700
DOI  :  10.1186/1471-2334-12-208

 received in 2012-03-02, accepted in 2012-08-06,  发布年份 2012

【 摘 要 】

Background

The delay in initiating treatment for tuberculosis (TB) in HIV-infected individuals may lead to the development of a more severe form of the disease, with higher rates of morbidity, mortality and transmissibility. The aim of the present study was to estimate the time interval between the onset of symptoms and initiating treatment for TB in HIV-infected individuals, and to identify the factors associated to this delay.

Methods

A nested case-control study was undertaken within a cohort of HIV-infected individuals, attended at two HIV referral centers, in the state of Pernambuco, Brazil. Delay in initiating treatment for TB was defined as the period of time, in days, which was greater than the median value between the onset of cough and initiating treatment for TB. The study analyzed biological, clinical, socioeconomic, and lifestyle factors as well as those related to HIV and TB infection, potentially associated to delay. The odds ratios were estimated with the respective confidence intervals and p-values.

Results

From a cohort of 2365 HIV-infected adults, 274 presented pulmonary TB and of these, 242 participated in the study. Patients were already attending 2 health services at the time they developed a cough (period range: 1 – 552 days), with a median value of 41 days. Factors associated to delay were: systemic symptoms asthenia, chest pain, use of illicit drugs and sputum smear-negative.

Conclusion

The present study indirectly showed the difficulty of diagnosing TB in HIV-infected individuals and indicated the need for a better assessment of asthenia and chest pain as factors that may be present in co-infected patients. It is also necessary to discuss the role played by negative sputum smear results in diagnosing TB/HIV co-infection as well as the need to assess the best approach for drug users with TB/HIV.

【 授权许可】

   
2012 Coimbra et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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