ABSTRACT
OBJECTIVES: To estimate the probability of survival and to evaluate risk factors for death in a cohort of persons living with human immunodeficiency virus (PLHIV) who had started tuberculosis (TB) treatment. METHODS: A prospective cohort study was conducted between June 2007 and December 2009 with HIV-infected patients who had started anti-tuberculosis treatment in the State of Pernambuco, Brazil. Survival data were analysed using the Kaplan-Meier estimator, the log-rank test and the Cox model. Hazard ratios and their respective 95%CIs were estimated. RESULTS: Of a cohort of 2310 HIV-positive individuals, 333 patients who had commenced treatment for TB were analysed. The mortality rate was 5.25 per 10,000 person-years (95%CI 4.15-6.63). The probability of survival at 30 months was 74%. Risk factors for death in the study population were being female, age ≥30 years, having anaemia, not using highly active antiretroviral therapy (HAART) during treatment for TB and disseminated TB. Protective factors for death were a CD4 lymphocyte count >200 cells/mm(3) and treatment for TB having started in an out-patient clinic. CONCLUSIONS: The use of HAART can prevent deaths among HIV-TB patients, corroborating the efficacy of starting HAART early in individuals with TB.
Subject(s)
Antiretroviral Therapy, Highly Active/methods , HIV Infections/mortality , Tuberculosis/mortality , Adolescent , Adult , Aged , Anemia/epidemiology , Anemia/etiology , Antitubercular Agents/therapeutic use , Brazil/epidemiology , CD4 Lymphocyte Count , Cohort Studies , Female , HIV Infections/drug therapy , HIV Infections/epidemiology , Humans , Kaplan-Meier Estimate , Male , Middle Aged , Proportional Hazards Models , Prospective Studies , Risk Factors , Sex Factors , Survival Analysis , Survival Rate , Tuberculosis/drug therapy , Tuberculosis/epidemiology , Young AdultABSTRACT
Although it has not been definitely proven that the severity of malaria is associated to human immunodeficiency virus (HIV) we know that infection through Plasmodium falciparum can favor a rapid evolution of the HIV infection. Besides, association of malaria with HIV/AIDS from a clinical point of view can be clinically severe in the face of the occurrence of other microorganisms or neoplasias, which worsens the evolution and prognosis of the affected patients. The concurrence of HIV with Plasmodium in malaria endemic zones is a possibility which should always be taken into consideration, since transmission is related to risk factors caused by people's behavior which are not always promptly revealed and/or identified. The authors report one case of brain malaria infection by Plasmodium vivax and Plasmodium falciparum in a patient with AIDS. They describe the clinical evolution and therapy.
Subject(s)
Acquired Immunodeficiency Syndrome/complications , Malaria, Cerebral/complications , Acquired Immunodeficiency Syndrome/diagnosis , Adult , Enzyme-Linked Immunosorbent Assay , Humans , Malaria, Cerebral/diagnosis , Malaria, Cerebral/drug therapy , MaleABSTRACT
Embora nao esteja definitivamente comprovada que a severidade da malária esteja associada com o vírus da imunodeficiência humana (HIV), sabe-se que a infecçao pelo Plasmodium falciparum pode favorece uma rápida evoluçao da infecçao pelo HIV. Além disso a associaçao da malária com HIV/AIDS, do ponto de vista clínico, pode ser extremamente grave face a ocorrência de outros microorganismos e/ou neoplasias, o que piora a evoluçao e prognóstico dos pacientes. A concomitância do vírus HIV com o Plasmodium em zonas endêmicas de malária, é uma possibilidade que deve ser sempre pensada, visto que a sua transmissao está relacionada a fatores de risco ligados aos comportamentos das pessoas, que nem sempre sao logo revelados e/ou identificados. Os autores descrevem um caso de malária cerebral Plasmodium vivax e Plasmodium falciparum em um paciente com AIDS. Descrevem sua evoluçao clínica e terapêutica.
