Epidemiological and clinical profile of tuberculosis (TB) patients by HIV status in Brazil: a hierarchical analysis

Wednesday, 20 August 2014
Exhibit hall (Dena'ina Center)
Thiago N do Prado, MS , Federal University of Espirito Santo, Vitoria, Brazil
Angélica E Miranda, PhD , Federal University of Espirito Santo, Vitória, Brazil
Fernanda M Souza, BS , Federal University Espirito Santo, Vitoria, Brazil
Elias S Dias, BS , Federal University of Espirito Santo, Vitoria, Brazil
Denise A Sanchez, MS , Ministério da Saúde, Brasilia, Brazil
Jonathan E Golub, PhD , Johns Hopkins University, Baltimore, MD
Mauro N Sanchez, PhD , Universidade de Brasilia, Brasilia, Brazil
Ethel L Noia Maciel, PhD , Federal University of Espirito Santo, Vitoria, Brazil
INTRODUCTION: Over the last decade TB incidence and mortality in Brazil have been steadily declining. However, this downward trend has not been observed among HIV-infected patients. We describe the epidemiological and clinical profile of TB patients by HIV status using the Brazilian National Surveillance System.

METHODS: All TB diagnoses with HIV status information between January 1, 2007 and December 31, 2011 were categorized as either HIV or non-HIV related at time of TB diagnosis. Co-infected patients (TB-HIV) were compared to TB patients with no HIV-infection using a hierarchical logistic regression model using Stata 12.0.  

RESULTS: The prevalence of TB-HIV co-infection was 10.8% (95% CI, 10.7% – 12.9%) among adults ≥ 15 years of age. We analyzed 243,676 subjects, of whom 46,466 were TB-HIV and 197,210 were only TB cases. Subjects with TB-HIV were more likely to be male (OR: 1.06, 95% CI 1.03-1.10), aged between 20 to 39 years (OR = 4.82, 95% CI 4.34-5.36), black  (OR=1.08, 95% CI 1.04-1.13), having school level between 4-7 years (OR = 1.13, 95% CI 1.19-1.28), return after default (OR = 2.65, 95% CI 1.13-6.25), present Pulmonary and Extrapulmonary forms simultaneously (OR=2.80, 95% CI 1.56-5.02),  present histopathologic examination suggestive of TB (OR=2.15, 95% CI 1.13-4.07) and were more likely to get unfavorable outcomes of TB treatment as default (OR= 2.96, 95% CI 2.36-3.71) and death from TB (OR= 5.16, 95% CI 43.04-5.77).  On the other hand, TB–HIV patients were less likely to live in rural areas (OR=0.45, 95% CI 0.42-0.48), have diabetes (OR=0.45, 95% CI 0.40-0.50) and be smear positive (OR= 0.55, 95% CI 0.32-0.95). 

CONCLUSIONS:  This analysis allowed us to understand which characteristics explain  differences between HIV and non-HIV related TB in Brazil. Understanding these differences provides evidence for targeted interventions directed towards these different risk groups.

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