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Factors associated with unfavorable evolution of tuberculosis in HIV infected persons

  • 1, 2Email author,
  • 1, 2,
  • 1, 2,
  • 2,
  • 2,
  • 2,
  • 2 and
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BMC Infectious Diseases201313 (Suppl 1) :P16

https://doi.org/10.1186/1471-2334-13-S1-P16

  • Published:

Keywords

  • Tuberculosis
  • Mycobacterium Tuberculosis
  • Opportunistic Infection
  • Positive Smear
  • Severe Immunosuppression

Background

Tuberculosis (TB) is one of the most common opportunistic infections in HIV-infected patients, with severe evolutive potential.

We evaluated the prevalence and the clinical aspects of TB in HIV-infected persons in order to identify factors associated with unfavorable evolution of TB.

Methods

We performed an observational, retrospective study (01 January 2009 – 31 December 2011) on 387 HIV-infected patients in evidence at the HIV/AIDS Craiova Regional Center. We analyzed the epidemiological, clinical and paraclinical data (smears and cultures for Mycobacterium tuberculosis, immunovirological evaluation) for patients who presented at least 2 times per year at the regional center.

Results

During the studied period 59 patients (15.3%) presented TB (9 cases simultaneously diagnosed with HIV and TB). General data on the study group: average age at the moment of TB diagnosis: 25.5±7.4 years; equal gender distribution: male/female 30/29; rural/urban 40/19 (67.8/32.2%); average CD4 count 3 months before TB diagnosis: 179±204 cells/cmm; average viral load: 5.09±5.3 log10. TB was: pulmonary: 46 cases (77.9%), extrapulmonary 8 (13.6%), multiple locations 5 (8.5%). 19 cases (32.2%) were bacteriologically confirmed (positive smears and/or positive cultures). 53 patients (89.8%) were under antiretroviral treatment, with a very good adherence in 19 patients (32.2%). Other opportunistic infections apart from TB were recorded in 28 patients (47.4%). 29 patients (49.2%) had favorable outcome, complication or relapse occurred in 10 cases (16.9%) and 20 patients (33.9%) died. Factors associated with unfavorable evolution were: delay in the introduction of anti-TB treatment more than 30 days from the first symptom (p=0.001); the presence of other opportunistic infections apart from TB (p=0.0001), low adherence to treatment (p=0.0001). Death was associated with extrapulmonary/multiple location of TB (p=0.005) and average CD4<100 cells/cmm (p=0.002).

Conclusion

Tuberculosis is common in patients infected with HIV, the unfavorable evolution being associated with severe immunosuppression, extrapulmonary TB location, poor adherence and delay in the introduction of anti-TB treatment.

Authors’ Affiliations

(1)
University of Medicine and Pharmacy Craiova, Romania
(2)
“Victor Babeş” Clinical Hospital of Infectious Diseases and Pneumology, Craiova, Romania

Copyright

© Dumitrescu et al; licensee BioMed Central Ltd. 2013

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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