Prevalence of hepatitis C virus and human immunodeficiency virus in a group of patients newly diagnosed with active tuberculosis in Porto Alegre, Southern Brazil.

BACKGROUND: Porto Alegre is the Brazilian state capital with second highest incidence of tuberculosis (TB) and the highest proportion of people infected with human immunodeficiency virus (HIV) among patients with TB. Hepatitis C virus (HCV) infection increases the risk of anti-TB drug-induced hepatotoxicity, which may result in discontinuation of the therapy. OBJECTIVES: The aim of this study was (i) to estimate prevalence of HCV and HIV in a group of patients newly diagnosed with active TB in a public reference hospital in Porto Alegre and (ii) to compare demographic, behavioural, and clinical characteristics of patients in relation to their HCV infection status. METHODS: One hundred and thirty-eight patients with TB were tested for anti-HCV antibody, HCV RNA, and anti-HIV1/2 antibody markers. HCV RNA from real-time polymerase chain reaction (PCR)-positive samples was submitted to reverse transcription and PCR amplification. The 5' non-coding region of the HCV genome was sequenced, and genotypes of HCV isolates were determined. FINDINGS: Anti-HCV antibody, HCV RNA, and anti-HIV antibodies were detected in 27 [20%; 95% confidence interval (CI), 13-26%], 17 (12%; 95% CI, 7-18%), and 34 (25%; 95% CI, 17-32%) patients, respectively. HCV isolates belonged to genotypes 1 (n = 12) and 3 (n = 4). Some characteristics were significantly more frequent in patients infected with HCV. Among them, non-white individuals, alcoholics, users of illicit drugs, imprisoned individuals, and those with history of previous TB episode were more commonly infected with HCV (p < 0.05). MAIN CONCLUSIONS: HCV screening, including detection of anti-HCV antibody and HCV RNA, will be important to improving the management of co-infected patients, given their increased risk of developing TB treatment-related hepatotoxicity.

Polymorphisms in CYP2E1, GSTM1 and GSTT1 and anti-tuberculosis drug-induced hepatotoxicity.

Anti-tuberculosis drug-induced hepatitis (ATD- induced hepatitis) has been linked to polymorphisms in genes encoding drug metabolizing enzymes. N-acetyltransferase 2 (NAT2), cytochrome P450 2E1 (CYP2E1) and glutathione S-transferase (loci GSTM1 and GSTT1) are involved in the metabolism of isoniazid, the most toxic drug for the treatment of tuberculosis (TB). This study was designed to determine the frequency and to evaluate whether polymorphisms at CYP2E1, GSTM1 and GSTT1 genes are associated with drug response, as well as to identify clinical risk factors for ATD-induced hepatitis. A total of 245 Brazilian patients undergoing treatment for TB were genotyped using polymerase chain reaction and restriction fragment length polymorphism and sequencing methods. The frequencies of the CYP2E1 polymorphic alleles RsaI, PstI and DraI are 8%, 8.5% and 12%, respectively. GSTM1 and GSTT1 genes are deleted in 42.9% and 12.4% of the population, respectively. Fifteen patients (6.1%) developed hepatotoxicity. Clinical (HIV, female sex and extrapulmonary TB) and genetic characteristics (CYP2E1 without any mutations, having NAT2 slow acetylator profile) are at higher risk of developing ATD-induced hepatitis in this population. Genotyping for GSTM1 and GSTT1 showed no influence on drug response.

Completeness of tuberculosis information system data from prisoners in the state Rio Grande do Sul, Brazil. / Completude dos dados do sistema de informações de tuberculose de pessoas privadas de liberdade do Rio Grande do Sul, Brasil.

Tuberculosis (TB) has a high incidence in several countries and is even more severe in prisoners. We evaluated the completeness of prisoners TB notifications in the Notifiable Disease Information System (SINAN) carried out by prison primary care teams (eAPP) or by other health facilities in the state of Rio Grande do Sul (RS). This descriptive cross-sectional study used prisoners data notifications in the SINAN TB by the eAPP or other health facilities from January 2014 to November 2018. We analyzed the percentage of completeness of the variables: gender, ethnicity, schooling, HIV, entry type, sputum smear, sputum culture, AIDS, ART during TB treatment, directly observed treatment (DOT), sixth-month smear, and closure status. Around 52.9% of TB cases in prisoners were reported by eAPP, and other health facilities reported 47.1% of the cases. Eighty percent of the variables were classified in category 4 (75.1% to 100% completeness). However, the DOT and sixth-month smear variables were classified into category 3 (50.1% and 75% completeness). While it does not compromise the notification of TB in the SINAN, the lack of data can impair the quality of information about the disease.

A tuberculose (TB) apresenta incidências elevadas em todo o mundo, sendo ainda mais grave em pessoas privadas de liberdade (PPL). Foi avaliada a completude das notificações de TB de PPL no SINAN realizadas por equipes de atenção primária prisional (eAPP) ou por outros estabelecimentos de saúde do RS. Estudo descritivo, transversal, utilizando dados de notificações de PPL feitas no SINAN TB pelas eAPP ou por outros estabelecimentos de saúde, de janeiro de 2014 a novembro de 2018. Foi analisado o percentual de completude das variáveis: sexo, raça/cor, escolaridade, HIV, tipo de entrada, baciloscopia de escarro, cultura do escarro, Aids, tratamento antirretroviral durante o tratamento para a TB, tratamento diretamente observado (TDO), baciloscopia de 6º mês e situação de encerramento. Praticamente 53% dos casos de TB em PPL foram notificados por eAPP, e 47,1% foram notificados por outros estabelecimentos de saúde. Oitenta por cento das variáveis foram classificadas na categoria 4 (75,1% a 100% de completude). No entanto, as variáveis TDO e baciloscopia de 6º mês foram classificadas na categoria 3 (50,1% e 75% de completude). Embora não comprometa a notificação da TB no SINAN, a ausência de dados pode prejudicar a qualidade das informações sobre a doença.

Tuberculosis in prison inmates in Southern Brazil: investigating the epidemiological and operational indicators.

BACKGROUND: Tuberculosis is a worldwide public health problem and is more prevalent in specific populations, such as prisoners. The aim of this study was to analyze the epidemiological and operational indicators of tuberculosis in prisoners in a southern region of Brazil. METHODS: This was a descriptive, observational study, utilizing secondary data from the Notifiable Diseases Information System on tuberculosis cases diagnosed in prisoners in the state of Rio Grande do Sul, southern Brazil, from 2014 to 2018. Prisoner data used to calculate incidence were extracted from reports by the National Penitentiary Department. RESULTS: From 2014 to 2018, 3,557 tuberculosis cases were reported in Rio Grande do Sul prisoners. The incidence rate of tuberculosis in prisoners was 1,235/100,000 individuals in 2014 and 1,430/100,000 individuals in 2018. The proportion of new TB cases tested for HIV was high, 83.4% in this period; among those tested, 12.9% were HIV coinfected. The proportion of new cases of pulmonary tuberculosis confirmed by laboratory criteria was 52.6% in this period. In total, 18.4% of new pulmonary tuberculosis cases were initiated on directly observed treatment in this period, and 36.4% of contacts of new cases of pulmonary tuberculosis with laboratory confirmation were examined. Among retreatment pulmonary tuberculosis cases, 82.4% were laboratory-confirmed. CONCLUSIONS: Tuberculosis incidence is increasing on a per-capita and absolute basis in Rio Grande do Sul. Laboratory confirmation, HIV testing, directly observed treatment, and contact investigation rates were all low, indicating the need to improve medical and public health measures for tuberculosis control in prisons.

Comparison of two laboratory-developed PCR methods for the diagnosis of pulmonary tuberculosis in Brazilian patients with and without HIV infection.

BACKGROUND: Direct smear examination with Ziehl-Neelsen (ZN) staining for the diagnosis of pulmonary tuberculosis (PTB) is cheap and easy to use, but its low sensitivity is a major drawback, particularly in HIV seropositive patients. As such, new tools for laboratory diagnosis are urgently needed to improve the case detection rate, especially in regions with a high prevalence of TB and HIV. OBJECTIVE: To evaluate the performance of two in house PCR (Polymerase Chain Reaction): PCR dot-blot methodology (PCR dot-blot) and PCR agarose gel electrophoresis (PCR-AG) for the diagnosis of Pulmonary Tuberculosis (PTB) in HIV seropositive and HIV seronegative patients. METHODS: A prospective study was conducted (from May 2003 to May 2004) in a TB/HIV reference hospital. Sputum specimens from 277 PTB suspects were tested by Acid Fast Bacilli (AFB) smear, Culture and in house PCR assays (PCR dot-blot and PCR-AG) and their performances evaluated. Positive cultures combined with the definition of clinical pulmonary TB were employed as the gold standard. RESULTS: The overall prevalence of PTB was 46% (128/277); in HIV+, prevalence was 54.0% (40/74). The sensitivity and specificity of PCR dot-blot were 74% (CI 95%; 66.1%-81.2%) and 85% (CI 95%; 78.8%-90.3%); and of PCR-AG were 43% (CI 95%; 34.5%-51.6%) and 76% (CI 95%; 69.2%-82.8%), respectively. For HIV seropositive and HIV seronegative samples, sensitivities of PCR dot-blot (72% vs 75%; p=0.46) and PCR-AG (42% vs 43%; p=0.54) were similar. Among HIV seronegative patients and PTB suspects, ROC analysis presented the following values for the AFB smear (0.837), Culture (0.926), PCR dot-blot (0.801) and PCR-AG (0.599). In HIV seropositive patients, these area values were (0.713), (0.900), (0.789) and (0.595), respectively. CONCLUSION: Results of this study demonstrate that the in house PCR dot blot may be an improvement for ruling out PTB diagnosis in PTB suspects assisted at hospitals with a high prevalence of TB/HIV.

Prospective study applying spoligotyping directly to DNA from sputum samples of patients suspected of having tuberculosis.

A prospective study was designed to evaluate the clinical usefulness of spoligotyping applied directly to sputum samples. Patients suspected of having tuberculosis were recruited at the Hospital Sanatorio Partenon in Porto Alegre, Brazil. Of the 197 samples included in the analysis, 175 (88.8%) yielded a spoligotyping result that fully matched that obtained from culture. Low bacillary samples presented lower accuracy (50%). From 135 Mycobacterium tuberculosis spoligopatterns, we identified 44 different spoligotypes, of which 21 were shared patterns and 23 were unique. T1 was the most frequent subfamily. The genotyping strategy proposed here presents a short turnaround time and could be helpful in providing rapid information on strain identities in a clinical setting.

PCR colorimetric dot-blot assay and clinical pretest probability for diagnosis of Pulmonary Tuberculosis in smear-negative patients.

BACKGROUND: Smear-negative pulmonary tuberculosis (SNPTB) accounts for 30% of Pulmonary Tuberculosis (PTB) cases reported annually in developing nations. Polymerase chain reaction (PCR) may provide an alternative for the rapid detection of Mycobacterium tuberculosis (MTB); however little data are available regarding the clinical utility of PCR in SNPTB, in a setting with a high burden of TB/HIV co-infection. METHODS: To evaluate the performance of the PCR dot-blot in parallel with pretest probability (Clinical Suspicion) in patients suspected of having SNPTB, a prospective study of 213 individuals with clinical and radiological suspicion of SNPTB was carried out from May 2003 to May 2004, in a TB/HIV reference hospital. Respiratory specialists estimated the pretest probability of active disease into high, intermediate, low categories. Expectorated sputum was examined by direct microscopy (Ziehl-Neelsen staining), culture (Lowenstein Jensen) and PCR dot-blot. Gold standard was based on culture positivity combined with the clinical definition of PTB. RESULTS: In smear-negative and HIV subjects, active PTB was diagnosed in 28.4% (43/151) and 42.2% (19/45), respectively. In the high, intermediate and low pretest probability categories active PTB was diagnosed in 67.4% (31/46), 24% (6/25), 7.5% (6/80), respectively. PCR had sensitivity of 65% (CI 95%: 50%-78%) and specificity of 83% (CI 95%: 75%-89%). There was no difference in the sensitivity of PCR in relation to HIV status. PCR sensitivity and specificity among non-previously TB treated and those treated in the past were, respectively: 69%, 43%, 85% and 80%. The high pretest probability, when used as a diagnostic test, had sensitivity of 72% (CI 95%:57%-84%) and specificity of 86% (CI 95%:78%-92%). Using the PCR dot-blot in parallel with high pretest probability as a diagnostic test, sensitivity, specificity, positive and negative predictive values were: 90%, 71%, 75%, and 88%, respectively. Among non-previously TB treated and HIV subjects, this approach had sensitivity, specificity, positive and negative predictive values of 91%, 79%, 81%, 90%, and 90%, 65%, 72%, 88%, respectively. CONCLUSION: PCR dot-blot associated with a high clinical suspicion may provide an important contribution to the diagnosis of SNPTB mainly in patients that have not been previously treated attended at a TB/HIV reference hospital.

Rastreio radiológico para tuberculose em uma penitenciária do sul do Brasil / Radiological screening for tuberculosis in a prison in the south of Brazil

Introdução: Conhecer o perfil da população privada de liberdade da Penitenciária Modulada de Osório (PMO), do ponto de vista radiológico e estimar a prevalência da tuberculose ativa no presídio.Métodos: Foi realizada análise retrospectiva de 677 radiografias de tórax obtidas para rastreio de tuberculose e de dados da ficha de atendimento do setor de Radiologia no período de julho a outubro de 2019.Resultados: Foram detectadas 150 radiografias alteradas, o que representa 22% dos 677 exames. Dos 150 exames alterados, 109 (16% do total e 72% dos alterados) apresentavam lesões com características de doença granulomatosa. Dos 677 pacientes, 11,5% referiram tratamento atual ou prévio para tuberculose e estes representam 38% dos casos com radiografias alteradas. Foram detectados 50 pacientes sem história prévia de tuberculose com lesões de aspecto muito provavelmente devido a tuberculose com características de doença ativa (7,3% do total), os quais foram encaminhados para investigação como casos novos. Em relação ao questionário aplicado, não foi observada diferença significativa entre os pacientes que referiam ou negavam tosse entre os com exames normais e alterados.Conclusões: Os indivíduos privados de liberdade apresentaram alta prevalência de alterações radiológicas com aspecto sugestivo de doença granulomatosa. Estes achados permitem inferir que na Penitenciária Modulada de Osório há elevada prevalência de tuberculose, provavelmente em níveis semelhantes a outras casas prisionais do Brasil.

Introduction: To determine the radiologic profile of 'the prisoners at Osório Modular Prison and estimate the prevalence of active tuberculosis in the institution.Methods: We retrospectively analyzed 677 chest radiographs obtained for tuberculosis screening and data from the medical records of prisoners seen at the Radiology Department from July to October 2019.Results: Of 677 radiographs, 150 (22%) showed abnormalities. Of these, 109 (16% of total or 72% of abnormal radiographs) showed lesions characteristic of granulomatous disease. Of all 677 patients, 11.5% reported current or previous treatment of tuberculosis, accounting for 38% of all abnormal radiographs. Fifty patients with no previous history of tuberculosis had lesions that were most likely due to active tuberculosis (7.3% of total), and were referred for further investigation as new cases. The responses to the questionnaire revealed no significant difference between patients who reported or denied coughing when comparing those with normal vs abnormal radiographs.Conclusions: Individuals deprived of liberty had a high prevalence of radiologic abnormalities suggestive of granulomatous disease. These findings allow us to infer that there is a high prevalence of tuberculosis at Osório Modular Prison, probably at levels comparable to those of other prison facilities in Brazil.

Completude dos dados do sistema de informações de tuberculose de pessoas privadas de liberdade do Rio Grande do Sul, Brasil / Completeness of tuberculosis information system data from prisoners in the state Rio Grande do Sul, Brazil

Resumo A tuberculose (TB) apresenta incidências elevadas em todo o mundo, sendo ainda mais grave em pessoas privadas de liberdade (PPL). Foi avaliada a completude das notificações de TB de PPL no SINAN realizadas por equipes de atenção primária prisional (eAPP) ou por outros estabelecimentos de saúde do RS. Estudo descritivo, transversal, utilizando dados de notificações de PPL feitas no SINAN TB pelas eAPP ou por outros estabelecimentos de saúde, de janeiro de 2014 a novembro de 2018. Foi analisado o percentual de completude das variáveis: sexo, raça/cor, escolaridade, HIV, tipo de entrada, baciloscopia de escarro, cultura do escarro, Aids, tratamento antirretroviral durante o tratamento para a TB, tratamento diretamente observado (TDO), baciloscopia de 6º mês e situação de encerramento. Praticamente 53% dos casos de TB em PPL foram notificados por eAPP, e 47,1% foram notificados por outros estabelecimentos de saúde. Oitenta por cento das variáveis foram classificadas na categoria 4 (75,1% a 100% de completude). No entanto, as variáveis TDO e baciloscopia de 6º mês foram classificadas na categoria 3 (50,1% e 75% de completude). Embora não comprometa a notificação da TB no SINAN, a ausência de dados pode prejudicar a qualidade das informações sobre a doença.

Abstract Tuberculosis (TB) has a high incidence in several countries and is even more severe in prisoners. We evaluated the completeness of prisoners TB notifications in the Notifiable Disease Information System (SINAN) carried out by prison primary care teams (eAPP) or by other health facilities in the state of Rio Grande do Sul (RS). This descriptive cross-sectional study used prisoners data notifications in the SINAN TB by the eAPP or other health facilities from January 2014 to November 2018. We analyzed the percentage of completeness of the variables: gender, ethnicity, schooling, HIV, entry type, sputum smear, sputum culture, AIDS, ART during TB treatment, directly observed treatment (DOT), sixth-month smear, and closure status. Around 52.9% of TB cases in prisoners were reported by eAPP, and other health facilities reported 47.1% of the cases. Eighty percent of the variables were classified in category 4 (75.1% to 100% completeness). However, the DOT and sixth-month smear variables were classified into category 3 (50.1% and 75% completeness). While it does not compromise the notification of TB in the SINAN, the lack of data can impair the quality of information about the disease.

Tuberculosis in prison inmates in Southern Brazil: investigating the epidemiological and operational indicators

ABSTRACT Background: Tuberculosis is a worldwide public health problem and is more prevalent in specific populations, such as prisoners. The aim of this study was to analyze the epidemiological and operational indicators of tuberculosis in prisoners in a southern region of Brazil. Methods: This was a descriptive, observational study, utilizing secondary data from the Notifiable Diseases Information System on tuberculosis cases diagnosed in prisoners in the state of Rio Grande do Sul, southern Brazil, from 2014 to 2018. Prisoner data used to calculate incidence were extracted from reports by the National Penitentiary Department. Results: From 2014 to 2018, 3,557 tuberculosis cases were reported in Rio Grande do Sul prisoners. The incidence rate of tuberculosis in prisoners was 1,235/100,000 individuals in 2014 and 1,430/100,000 individuals in 2018. The proportion of new TB cases tested for HIV was high, 83.4% in this period; among those tested, 12.9% were HIV coinfected. The proportion of new cases of pulmonary tuberculosis confirmed by laboratory criteria was 52.6% in this period. In total, 18.4% of new pulmonary tuberculosis cases were initiated on directly observed treatment in this period, and 36.4% of contacts of new cases of pulmonary tuberculosis with laboratory confirmation were examined. Among retreatment pulmonary tuberculosis cases, 82.4% were laboratory-confirmed. Conclusions: Tuberculosis incidence is increasing on a per-capita and absolute basis in Rio Grande do Sul. Laboratory confirmation, HIV testing, directly observed treatment, and contact investigation rates were all low, indicating the need to improve medical and public health measures for tuberculosis control in prisons.

HIV behind bars: human immunodeficiency virus cluster analysis and drug resistance in a reference correctional unit from southern Brazil.

People deprived of liberty in prisons are at higher risk of infection by the human immunodeficiency virus (HIV) due to their increased exposure through intravenous drug use, unprotected sexual activity, tattooing in prison and blood exposure in fights and rebellions. Yet, the contribution of intramural HIV transmission to the epidemic is scarcely known, especially in low- and middle-income settings. In this study, we surveyed 1,667 inmates incarcerated at Presídio Central de Porto Alegre, located in southern Brazil, for HIV infection and molecular characterization. The HIV seroprevalence was 6.6% (110/1,667). Further analyses were carried out on 40 HIV-seropositive inmates to assess HIV transmission clusters and drug resistance within the facility with the use of molecular and phylogenetic techniques. The molecular epidemiology of HIV-1 subtypes observed was similar to the one reported for the general population in southern Brazil, with the predominance of HIV-1 subtypes C, B, CRF31_BC and unique BC recombinants. In particular, the high rate (24%) of URF_BC found here may reflect multiple exposures of the population investigated to HIV infection. We failed to find HIV-infected inmates sharing transmission clusters with each other. Importantly, the analysis of HIV-1 pol genomic fragments evidenced high rates of HIV primary and secondary (acquired) drug resistance and an alarming proportion of virologic failure among patients under treatment, unveiling suboptimal access to antiretroviral therapy (ARV), low ARV adherence and dissemination of drug resistant HIV strains in primary infections. Our results call for immediate actions of public authority to implement preventive measures, serological screening and, for HIV-seropositive subjects, clinical and treatment follow-up in order to control HIV infection and limit the spread of drug resistance strains in Brazilian prisons.

Prevalence of hepatitis C virus and human immunodeficiency virus in a group of patients newly diagnosed with active tuberculosis in Porto Alegre, Southern Brazil

BACKGROUND Porto Alegre is the Brazilian state capital with second highest incidence of tuberculosis (TB) and the highest proportion of people infected with human immunodeficiency virus (HIV) among patients with TB. Hepatitis C virus (HCV) infection increases the risk of anti-TB drug-induced hepatotoxicity, which may result in discontinuation of the therapy. OBJECTIVES The aim of this study was (i) to estimate prevalence of HCV and HIV in a group of patients newly diagnosed with active TB in a public reference hospital in Porto Alegre and (ii) to compare demographic, behavioural, and clinical characteristics of patients in relation to their HCV infection status. METHODS One hundred and thirty-eight patients with TB were tested for anti-HCV antibody, HCV RNA, and anti-HIV1/2 antibody markers. HCV RNA from real-time polymerase chain reaction (PCR)-positive samples was submitted to reverse transcription and PCR amplification. The 5′ non-coding region of the HCV genome was sequenced, and genotypes of HCV isolates were determined. FINDINGS Anti-HCV antibody, HCV RNA, and anti-HIV antibodies were detected in 27 [20%; 95% confidence interval (CI), 13-26%], 17 (12%; 95% CI, 7-18%), and 34 (25%; 95% CI, 17-32%) patients, respectively. HCV isolates belonged to genotypes 1 (n = 12) and 3 (n = 4). Some characteristics were significantly more frequent in patients infected with HCV. Among them, non-white individuals, alcoholics, users of illicit drugs, imprisoned individuals, and those with history of previous TB episode were more commonly infected with HCV (p < 0.05). MAIN CONCLUSIONS HCV screening, including detection of anti-HCV antibody and HCV RNA, will be important to improving the management of co-infected patients, given their increased risk of developing TB treatment-related hepatotoxicity.

Reorganização administrativa de processos de trabalho do setor de tuberculose central como estratégia para controle da tuberculose no Rio Grande do Sul / Administrative reorganization of work processes of the central tuberculosis sector as strategy to control tuberculosis in Rio Grande do Sul

Apresentar a experiência de reorganização do Programa Estadual de Controle da Tuberculose do Rio Grande do Sul (PECT-RS) em relação aos processos internos de trabalho, bem como ao suporte técnico às Coordenadorias Regionais de Saúde (CRS), aos Serviços Municipais de Tuberculose do RS (SMT-RS) e às Unidades de Saúde da Família (USF) do Rio Grande do Sul (RS) com vistas ao seu empoderamento técnico. (AU)

Integração entre assistência farmacêutica e vigilância epidemiológica no contexto das ações do programa estadual de controle da tuberculose do Rio Grande do Sul / Integration between pharmaceutical services and epidemiological surveillance in the context of the actions of the state tuberculosis control program in Rio Grande do Sul

Este trabalho visa avaliar a adequação do armazenamento e da distribuição dos medicamentos nos seis primeiros meses de implantação da integração entre a assistência farmacêutica do Hospital Sanatório Partenon (HSP) e a vigilância epidemiológica no contexto do Programa Estadual de Controle da Tuberculose (PECTRS). (AU)

Descentralização do atendimento dos casos de tuberculose para Atenção Primária: um relato de experiência / Decentralization of the care of tuberculosis cases for Primary Care: an experience report

Este trabalho tem como objetivo descrever a experiência do processo de descentralização do tratamento da TB para a AP de modo a contribuir com as instituições e profissionais que ainda não desencadearam esse processo. (AU)

Projeto de apoio e monitoramento de um serviço de referência às unidades de saúde da Atenção Básica na descentralização do atendimento da tuberculose / Project of support and monitoring of a reference service to health care units Primary Care in the decentralization of tuberculosis care

Relatar a experiência do Centro de Referência Estadual para TB do Hospital Sanatório Partenon no desenvolvimento de intervenções de apoio às equipes de saúde da AB que iniciaram suas ações de controle da TB a partir de capacitação teórico-prática para descentralização do atendimento desse agravo. (AU)

Risk factors for recurrence of tuberculosis.

OBJECTIVE: To identify risk factors for recurrence of tuberculosis. METHODS: We studied a cohort of 610 patients with active pulmonary tuberculosis who were enrolled for treatment between 1989 and 1994 and cured using a three-drug treatment regimen of rifampin, isoniazid and pyrazinamide (RHZ). The risk factors studied were age, gender, race, duration of symptoms, lesion cavitation, extent of disease, diabetes mellitus, alcoholism, HIV infection, delayed negative sputum conversion, treatment compliance, and medication doses. In order to detect recurrence, the patients were monitored through the Rio Grande do Sul State Healt Department Information System for 7.7 +/- 2.0 years after cure. Data were analyzed using the Student's t-test, the chi-square test or Fisher's exact test, and Cox regression models. RESULTS: There were 26 cases of recurrence (4.3%), which corresponds to 0.55/100 patients-year. The recurrence rate was 5.95 and 0.48/100 patients-year in HIV-positive and HIV-negative patients, respectively (p < 0.0001). In the multivariate analysis, HIV infection [RR = 8.04 (95% CI: 2.35-27.50); p = 0.001] and noncompliance [RR = 6.43 (95% CI: 2.02-20.44); p = 0.002] proved to be independently associated with recurrence of tuberculosis. CONCLUSIONS: Recurrence of tuberculosis was more common in HIV-positive patients and in patients who did not comply with the self-administered treatment (RHZ regimen). Patients presenting at least one of these risk factors can benefit from the implementation of a post-treatment surveillance system for early detection of recurrence. An alternative to prevent noncompliance with tuberculosis treatment would be the use of supervised treatment.

Differences in the clinical and radiological presentation of intrathoracic tuberculosis in the presence or absence of HIV infection.

OBJECTIVE: To describe the differences in the clinical and radiological presentation of tuberculosis in the presence or absence of HIV infection. METHODS: A sample of 231 consecutive adults with active pulmonary tuberculosis admitted to a tuberculosis hospital were studied, assessing HIV infection, AIDS, and associated factors, as well as re-evaluating chest X-rays. RESULTS: There were 113 HIV-positive patients (49%) Comparing the 113 HIV-positive patients (49%) to the 118 HIV-negative patients (51%), the former presented a higher frequency of atypical pulmonary tuberculosis (pulmonary lesions accompanied by intrathoracic lymph node enlargement), hematogenous tuberculosis, and pulmonary tuberculosis accompanied by superficial lymph node enlargement, as well as presenting less pulmonary cavitation. The same was found when HIV-positive patients with AIDS were compared to those without AIDS. There were no differences between the HIV-positive patients without AIDS and the HIV-negative patients. Median CD4 counts were lower in HIV-positive patients with intrathoracic lymph node enlargement and pulmonary lesions than in the HIV-positive patients with pulmonary lesions only (47 vs. 266 cells/mm3; p < 0.0001), in HIV-positive patients with AIDS than in those without AIDS (136 vs. 398 cells/mm3; p < 0.0001) and in patients with atypical pulmonary tuberculosis than in those with other forms of tuberculosis (31 vs. 258 cells/mm3; p < 0.01). CONCLUSION: Atypical forms and disseminated disease predominate among patients with advanced immunosuppression. In regions where TB prevalence is high, the presence of atypical pulmonary tuberculosis or pulmonary tuberculosis accompanied by superficial lymph node enlargement should be considered an AIDS-defining condition.