Open AccessParticularities of tuberculosis in HIV‐infected patients: 10‐year experience of a Portuguese hospital
Author(s) -
Nunes S,
Coutinho D,
Maio A,
Velez J,
Freitas F,
Oliveira C
Publication year - 2012
Publication title -
journal of the international aids society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.724
H-Index - 62
ISSN - 1758-2652
DOI - 10.7448/ias.15.6.18408
Subject(s) - medicine , tuberculosis , extrapulmonary tuberculosis , incidence (geometry) , human immunodeficiency virus (hiv) , pediatrics , immunology , mycobacterium tuberculosis , pathology , physics , optics
The incidence of tuberculosis (TB) has dramatically increased since the advent of the human immunodeficiency virus (HIV) pandemic. In Portugal, tuberculosis is still common in HIV‐negative patients, despite earlier diagnosis and countrywide directly observed therapy strategies. With the purpose of comparing some demographic and clinical aspects of TB in HIV‐infected and uninfected patients, the authors reviewed the files of patients admitted with a diagnosis of tuberculosis between January 2002 and December 2011. During this time period, there were 234 cases of tuberculosis, 43 (18%) of which occurred in HIV‐infected patients. In this group, 74% of patients were male, with a mean age of 38±11 years and the majority (51%) acquired HIV from heterosexual risk behavior. The most common site of infection was the lung, in both groups, but cases of extrapulmonary TB were significantly higher in the HIV‐infected group (67% versus 39%, p<0.01). Disseminated TB was the most common extrapulmonary diagnosis in the former group (28%) and lymph node TB (8%) in the latter. The duration of hospitalization was not statistically different between the two groups (mean of 26±16 days in HIV‐infected patients and 21±15 days in the HIV‐negative group, p=0.21). The mean CD4 count at TB diagnosis was 180±177/mm 3 . In 11 (26%) of the patients, HIV was diagnosed during the TB episode and in 5 cases, the diagnosis of tuberculosis occurred with immune reconstitution syndrome. In the majority of patients (60%), TB was the first AIDS‐defining condition. In 26 (60%) of patients there was microbiologic confirmation of TB, mainly by direct observation (69%), positive culture (46%) and molecular diagnostic technics (27%). While most patients were treated with the 4‐drug standard regimen, 16 (37%) of cases received alternative treatment. The mean duration of treatment was 8.5±4.8 months and the majority of patients (58%) were considered cured. About one‐third of patients were lost to follow‐up (32%). Tuberculosis is a heterogeneous disease, varying accordingly with the immunologic status of the host. The risk of extrapulmonary and disseminated TB increases with immunosuppression but, in this cohort, it did not seem to influence the length of hospitalization. The authors alert to the need of HIV screening whenever TB occurs, allowing for earlier diagnosis and prompt start of antiretroviral therapy.