title: Associated factors for treatment delay in pulmonary tuberculosis in HIV-infected individuals: a nested case-control study.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Universidade Federal de Pernambuco, Rua Antonio Rabelo 245, Madalena, Recife, PE, Brazil. isabella.coimbra@uol.com.br
authors.forename: Isabella
authors.initials: I
authors.lastname: Coimbra
authors.forename: Magda
authors.initials: M
authors.lastname: Maruza
authors.forename: Maria de Fátima Pessoa
authors.initials: Mde F
authors.lastname: Militão-Albuquerque
authors.forename: Líbia Vilela
authors.initials: LV
authors.lastname: Moura
authors.forename: George Tadeu Nunes
authors.initials: GT
authors.lastname: Diniz
authors.forename: Demócrito de Barros
authors.initials: Dde B
authors.lastname: Miranda-Filho
authors.forename: Heloísa Ramos
authors.initials: HR
authors.lastname: Lacerda
authors.forename: Laura Cunha
authors.initials: LC
authors.lastname: Rodrigues
authors.forename: Ricardo Arraes de Alencar
authors.initials: RA
authors.lastname: Ximenes
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000008:administration & dosage; D001938:Brazil; D016022:Case-Control Studies; D057210:Delayed Diagnosis; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000188:drug therapy; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents