Prevalence and Clinical Profiling of Dysglycemia and HIV Infection in Persons With Pulmonary Tuberculosis in Brazil

Frontiers in Medicine

Aline Benjamin¹  Valeria C. Rolla¹  Solange Cavalcante²  Jamile G. de Oliveira²  Betina Durovni²  José R. Lapa-e-Silva³  Afrânio L. Kristki³  Adriana S. R. Moreira³  Artur T. L. Queiroz⁴  Moreno M. S. Rodrigues⁵  Marina C. Figueiredo⁶  Timothy R. Sterling⁶  Bruno B. Andrade⁶  Marcelo Cordeiro-Santos⁷  Jaquelane Silva⁸  Juan M. Cubillos-Angulo⁸  the RePORT-Brazil consortium⁸  Mayla Mello⁸  Elisangela C. Silva⁸  Vanessa Nascimento⁸  Maria Cristina Lourenço⁸  Jéssica Rebouças-Silva⁸  Francine P. Ignácio⁸  Alice M. S. Andrade⁸  Alysson G. Costa⁸  Saulo R. N. Santos⁸  Adriano Gomes-Silva⁸  Flávia M. Sant'Anna⁸  André Ramos⁸  Hayna Malta-Santos⁸  Michael S. Rocha⁹  João Pedro Miguez-Pinto^1,10  Evelyn B. Nogueira^1,10  Caio Sales^1,10  María B. Arriaga^1,11  Mariana Araújo-Pereira^1,11  Betânia M. F. Nogueira^1,13  Beatriz Barreto-Duarte^1,16  Renata Spener-Gomes^1,17  Alexandra B. Souza^1,17 

[1] 0Laboratório de Pesquisa Clínica em Micobacteriose, Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Rio de Janeiro, Brazil;1Secretaria Municipal de Saúde do Rio de Janeiro, Rio de Janeiro, Brazil;2Programa Acadêmico de Tuberculose da Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil;3Center of Data and Knowledge Integration for Health, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil;4Laboratório de Análise e Visualização de Dados, Fundação Oswaldo Cruz, Porto Velho, Brazil;5Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, United States;6Faculdade de Medicina, Universidade Nilton Lins, Manaus, Brazil;;Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil;Escola de Medicina, Universidade Salvador (UNIFACS), Salvador, Brazil;Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil;Fundação Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil;Instituto Brasileiro para Investigação da Tuberculose, Fundação José Silveira, Salvador, Brazil;Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil;Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil;Programa de Pós-Graduação em Clínica Médica, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil;Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil;

关键词: dysglycemia;    HIV infection;    pulmonary tuberculosis;    Mycobacterium tuberculosis;    diabetes;   

DOI  :  10.3389/fmed.2021.804173

来源: DOAJ

【 摘 要 】

BackgroundThere are scarce data on the prevalence and disease presentation of HIV in patients with tuberculosis (TB) and dysglycemia (diabetes [DM] and prediabetes [PDM]), especially in TB-endemic countries.MethodsWe assessed the baseline epidemiological and clinical characteristics of patients with culture-confirmed pulmonary TB, enrolled in a multicenter prospective cohort in Brazil (RePORT-Brazil) during 2015–2019. Dysglycemia was defined by elevated glycated hemoglobin and stratified as PDM or DM. Additionally, we used data from TB cases obtained through the Brazilian National Notifiable Diseases Information System (SINAN), during 2015–2019. In SINAN, diagnosis of diabetes was based on self-report. Logistic regression models were performed to test independent associations between HIV, dysglycemia status, and other baseline characteristics in both cohorts.ResultsIn the RePORT-Brazil cohort, the prevalence of DM and of PDM was 23.7 and 37.8%, respectively. Furthermore, the prevalence of HIV was 21.4% in the group of persons with TB-dysglycemia and 20.5% in that of patients with TBDM. In the SINAN cohort, the prevalence of DM was 9.2%, and among the TBDM group the prevalence of HIV was 4.1%. Logistic regressions demonstrated that aging was independently associated with PDM or DM in both the RePORT-Brazil and SINAN cohorts. In RePORT-Brazil, illicit drug use was associated with PDM, whereas a higher body mass index (BMI) was associated with DM occurrence. Of note, HIV was not associated with an increased risk of PDM or DM in patients with pulmonary TB in both cohorts. Moreover, in both cohorts, the TBDM-HIV group presented with a lower proportion of positive sputum smear and a higher frequency of tobacco and alcohol users.ConclusionThere is a high prevalence of dysglycemia in patients with pulmonary TB in Brazil, regardless of the HIV status. This reinforces the idea that DM should be systematically screened in persons with TB. Presence of HIV does not substantially impact clinical presentation in persons with TBDM, although it is associated with more frequent use of recreational drugs and smear negative sputum samples during TB screening.

【 授权许可】

Unknown