title: Predictors of tuberculosis treatment outcomes.
abstract: OBJECTIVE
  To analyze tuberculosis treatment outcomes and their predictors.
  
  
  METHODS
  This was a retrospective longitudinal cohort study involving tuberculosis patients treated between 2004 and 2006 at the Instituto de Pesquisa Evandro Chagas, in the city of Rio de Janeiro. We estimated adjusted risk ratios (ARRs) for the predictors of treatment outcomes.
  
  
  RESULTS
  Among 311 patients evaluated, the rates of cure, treatment abandonment, treatment failure, and mortality were 72%, 19%, 2%, and 6%, respectively. Changes in the treatment regimen due to adverse events occurred in 8%. The factors found to reduce the probability of cure were alcoholism (ARR, 0.30), use of the streptomycin+ethambutol+ofloxacin (SEO) regimen (ARR, 0.32), HIV infection without the use of antiretroviral therapy (ART; ARR, 0.36), and use of the rifampin+isoniazid+pyrazinamide+ethambutol regimen (ARR, 0.58). Being younger and being alcoholic both increased the probability of abandonment (ARR, 3.84 and 1.76, respectively). It was impossible to determine the ARR for the remaining outcomes due to their low prevalence. However, using the relative risk (RR), we identified the following potential predictors of mortality: use of the SEO regimen (RR, 11.43); HIV infection without ART (RR, 9.64); disseminated tuberculosis (RR, 9.09); lack of bacteriological confirmation (RR, 4.00); diabetes mellitus (RR, 3.94); and homosexual/bisexual behavior (RR, 2.97). Low income was a potential predictor of treatment failure (RR, 11.70), whereas disseminated tuberculosis and HIV infection with ART were potential predictors of changes in the regimen due to adverse events (RR, 3.57 and 2.46, respectively).
  
  
  CONCLUSIONS
  The SEO regimen should not be used for extended periods. The data confirm the importance of ART and suggest the need to use it early.
authors.affiliation: Laboratório de Pesquisa Clínica em Micobacteriose, Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil. renataorofino@yahoo.com.br
authors.forename: Renata de Lima
authors.initials: Rde L
authors.lastname: Orofino
authors.forename: Pedro Emmanuel Americano do
authors.initials: PE
authors.lastname: Brasil
authors.forename: Anete
authors.initials: A
authors.lastname: Trajman
authors.forename: Carolina Arana Stanis
authors.initials: CA
authors.lastname: Schmaltz
authors.forename: Margareth
authors.initials: M
authors.lastname: Dalcolmo
authors.forename: Valéria Cavalcanti
authors.initials: VC
authors.lastname: Rolla
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects; D000995:Antitubercular Agents / Q000009:adverse effects*; D004359:Drug Therapy, Combination / Q000009:adverse effects / Q000145:classification; D004812:Epidemiologic Methods; D004977:Ethambutol / Q000009:adverse effects*; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy; D006801:Humans; D008297:Male; D015242:Ofloxacin / Q000009:adverse effects*; D010352:Patient Dropouts / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D013307:Streptomycin / Q000009:adverse effects*; D017211:Treatment Failure; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy / Q000401:mortality*; D016903:Drug Monitoring
chemical_list: D000995:Antitubercular Agents; D004977:Ethambutol; D015242:Ofloxacin; D013307:Streptomycin