title: Clinical and epidemiological characteristics associated with unfavorable tuberculosis treatment outcomes in TB-HIV co-infected patients in Brazil: a hierarchical polytomous analysis.
abstract: BACKGROUND
  TB patients co-infected with HIV have worse treatment outcomes than non-coinfected patients. How clinical characteristics of TB and socioeconomic characteristics influence these outcomes is poorly understood. Here, we use polytomous regression analysis to identify clinical and epidemiological characteristics associated with unfavorable treatment outcomes among TB-HIV co-infected patients in Brazil.
  
  
  METHODS
  TB-HIV cases reported in the Brazilian information system (SINAN) between January 1, 2001 and December 31, 2011 were identified and categorized by TB treatment outcome (cure, default, death, and development of MDR TB). We modeled treatment outcome as a function of clinical characteristics of TB and patient socioeconomic characteristics by polytomous regression analysis. For each treatment outcome, we used cure as the reference outcome.
  
  
  RESULTS
  Between 2001 and 2011, 990,017 cases of TB were reported in SINAN, of which 93,147 (9.4%) were HIV co-infected. Patients aged 15-19 (OR=2.86; 95% CI: 2.09-3.91) and 20-39 years old (OR=2.30; 95% CI: 1.81-2.92) were more likely to default on TB treatment than those aged 0-14 years old. In contrast, patients aged ≥60 years were more likely to die from TB (OR=2.22; 95% CI: 1.43-3.44) or other causes (OR=2.86; 95% CI: 2.14-3.83). Black patients were more likely to default on TB treatment (OR=1.33; 95% CI: 1.22-1.44) and die from TB (OR=1.50; 95% CI: 1.29-1.74). Finally, alcoholism was associated with all unfavorable outcomes: default (OR=1.94; 95% CI: 1.73-2.17), death due to TB (OR=1.46; 95% CI: 1.25-1.71), death due to other causes (OR=1.38; 95% CI: 1.21-1.57) and MDR-TB (OR=2.29; 95% CI: 1.46-3.58).
  
  
  CONCLUSIONS
  Socio-economic vulnerability has a significant effect on treatment outcomes among TB-HIV co-infected patients in Brazil. Enhancing social support, incorporation of alcohol abuse screening and counseling into current TB surveillance programs and targeting interventions to specific age groups are interventions that could improve treatment outcomes.
authors.affiliation: Universidade Federal do Espírito Santo (UFES), Laboratório de Epidemiologia (Lab-Epi), Vitória, ES, Brazil; Universidade Federal do Espírito Santo (UFES), Departamento de Enfermagem, Vitória, ES, Brazil; Universidade Federal do Espírito Santo (UFES), Programa de Pós-Graduação em Doenças Infecciosas, Vitória, ES, Brazil.
authors.forename: Thiago Nascimento do
authors.initials: TN
authors.lastname: Prado
authors.affiliation: University of California, Department of Medicine, San Francisco, United States.
authors.forename: Jayant V
authors.initials: JV
authors.lastname: Rajan
authors.affiliation: Universidade Federal do Espírito Santo (UFES), Programa de Pós-Graduação em Doenças Infecciosas, Vitória, ES, Brazil.
authors.forename: Angélica Espinosa
authors.initials: AE
authors.lastname: Miranda
authors.affiliation: Universidade Federal do Espírito Santo (UFES), Departamento de Enfermagem, Vitória, ES, Brazil.
authors.forename: Elias Dos Santos
authors.initials: ED
authors.lastname: Dias
authors.affiliation: Universidade Federal do Espírito Santo (UFES), Laboratório de Epidemiologia (Lab-Epi), Vitória, ES, Brazil; Universidade Federal do Espírito Santo (UFES), Departamento de Enfermagem, Vitória, ES, Brazil.
authors.forename: Lorrayne Beliqui
authors.initials: LB
authors.lastname: Cosme
authors.affiliation: Universidade de Santa Cruz do Sul, Programa de Pós-Graduação em Promoção da Saúde, Santa Cruz do Sul, RS, Brazil.
authors.forename: Lia Gonçalves
authors.initials: LG
authors.lastname: Possuelo
authors.affiliation: Universidade de Brasília, Departamento de Saúde Pública, Brasília, DF, Brazil; International Union Against Tuberculosis and Lung Disease, Paris, France.
authors.forename: Mauro N
authors.initials: MN
authors.lastname: Sanchez
authors.affiliation: University of Baltimore, Johns Hopkins School of Medicine, Center for Tuberculosis Research, Baltimore, United States.
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Golub
authors.affiliation: University of California, School of Public Health, Division of Infectious Disease and Vaccinology, Berkeley, United States.
authors.forename: Lee W
authors.initials: LW
authors.lastname: Riley
authors.affiliation: Universidade Federal do Espírito Santo (UFES), Laboratório de Epidemiologia (Lab-Epi), Vitória, ES, Brazil; Universidade Federal do Espírito Santo (UFES), Departamento de Enfermagem, Vitória, ES, Brazil; Universidade Federal do Espírito Santo (UFES), Programa de Pós-Graduação em Doenças Infecciosas, Vitória, ES, Brazil. Electronic address: ethel.maciel@gmail.com.
authors.forename: Ethel Leonor
authors.initials: EL
authors.lastname: Maciel
mesh_terms: D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D060085:Coinfection; D003430:Cross-Sectional Studies; D018563:Disease Notification; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D012959:Socioeconomic Factors; D017211:Treatment Failure; D014376:Tuberculosis / Q000150:complications* / Q000188:drug therapy* / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents
keywords: Coinfection; HIV; Logistic regression; Tuberculosis