Active tuberculosis and Mycobacterium tuberculosis latent infection in patients with HIV/AIDS.
OBJECTIVE
Tuberculosis (TB) remains an important disease associated with HIV infection and AIDS in Brazil, even in a setting of free access to antiretroviral therapy (ART) and TB treatment. In previous studies, isoniazid therapy (IT) for latent infection with Mycobacterium tuberculosis (LIMTb) was found to reduce the risk of TB by 62% in patients with a tuberculin test (TT)>5 mm. The objectives of this study were to investigate the occurrence of TB, the prevalence of LIMTb and the coverage of the TT and IT, and to estimate the number of missed opportunities to prevent TB in patients with HIV/AIDS.


METHODS
A random sample of patients with HIV/AIDS was selected; data from the medical files were obtained, and a TT was performed in consenting subjects.


RESULTS
In the 203 subjects included in the study, TB occurrence was 13.3%, LIMTb prevalence was 20% and the coverage of the TT and IT was 59.2 and 55%, respectively. Patients with TB had a lower nadir CD4 cell count, but their CD4 recovery was comparable to that of non-TB patients. Patients with LIMTb always had a higher CD4 cell count.


CONCLUSIONS
By expanding the coverage of the TT and IT to nearly 100%, we could more than double the number of prevented cases of TB. TB prevention programmes must be reinforced to reduce the number of missed opportunities for diagnosis, and IT must be improved to reduce TB among patients with HIV/AIDS. Empowering patients with knowledge about TB, the preventive role of IT and the need for an annual TT may be the best way of lowing rates of TB in patients with HIV/AIDS.
HIV/AIDS Outpatient Clinic, Clinicas Hospital, School of Medicine, São Paulo University, São Paulo, Brazil. elianabg@hcnet.usp.br
E B
EB
Gutierrez
V
V
Gomes
C M
CM
Picone
H
H
Suga
A N
AN
Atomiya
D000328:Adult; D000368:Aged; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D000995:Antitubercular Agents / Q000627:therapeutic use; D001938:Brazil / Q000453:epidemiology; D018791:CD4 Lymphocyte Count; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000635:transmission; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007538:Isoniazid / Q000627:therapeutic use; D055985:Latent Tuberculosis / Q000188:drug therapy / Q000453:epidemiology*; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D008875:Middle Aged; D009169:Mycobacterium tuberculosis; D015995:Prevalence; D017678:Sex Distribution; D012725:Sexual Behavior; D014374:Tuberculin Test / Q000706:statistics & numerical data; D014376:Tuberculosis / Q000453:epidemiology* / Q000517:prevention & control; D055815:Young Adult
D044966:Anti-Retroviral Agents; D000995:Antitubercular Agents; D007538:Isoniazid