HIV-related tuberculosis: mortality risk in persons without vs. with culture-confirmed disease.

BACKGROUND: Tuberculosis (TB) diagnosis in human immunodeficiency virus (HIV) positive persons is difficult, particularly in resource-limited settings. The relationship between TB culture status and mortality in HIV-positive persons treated for TB is unclear. METHODS: We evaluated HIV-positive adults treated for TB at or after their first HIV clinic visit in Argentina, Brazil, Chile, Honduras, Mexico or Peru from 2000 to 2015. Anti-tuberculosis treatment included 2 months of isoniazid, rifampicin (RMP)/rifabutin (RBT), pyrazinamide ± ethambutol, followed by continuation phase treatment with isoniazid + RMP/RBT. RESULTS: Of 759 TB-HIV patients, 238 (31%) were culture-negative, 228 (30%) had unknown culture status or did not undergo culture and 293 (39%) were culture-positive. The median CD4 at TB diagnosis was 96 (interquartile range 40-228); 636 (84%) received concurrent antiretroviral therapy (ART) and anti-tuberculosis treatment. There were 123 (16%) deaths: 90/466 (19%) with TB culture-negative, unknown or not performed vs. 33/293 (11%) who were TB culture-positive (P = 0.005). In Kaplan-Meier analysis, mortality in TB patients without culture-confirmed disease was higher (P = 0.002). In a Cox model adjusted for age, sex, CD4, ART timing, disease site and stratified by study site, mortality in persons without culture-confirmed TB was not significantly increased compared to those with culture-positive TB (hazard ratio 1.39, 95%CI 0.89-2.16, P = 0.15). CONCLUSION: Most HIV-positive patients treated for TB did not have culture-confirmed TB, and mortality tended to be higher in patients without culture-confirmed disease, although the association was not statistically different after adjusting for other variables. Accurate TB diagnosis in HIV-positive persons is crucial.

Trends in proportion of older HIV-infected people in care in Latin America and the Caribbean: a growing challenge.

We aimed to quantify the proportion of people receiving care for HIV-infection that are 50 years or older (older HIV patients) in Latin America and the Caribbean between 2000 and 2015 and to estimate the contribution to the growth of this population of people enrolled before (<50yo) and after 50 years old (yo) (⩾50yo). We used a series of repeated, cross-sectional measurements over time in the Caribbean, Central and South American network (CCASAnet) cohort. We estimated the percentage of patients retained in care each year that were older HIV patients. For every calendar year, we divided patients into two groups: those who enrolled before age 50 and after age 50. We used logistic regression models to estimate the change in the proportion of older HIV patients between 2000 and 2015. The percentage of CCASAnet HIV patients over 50 years had a threefold increase (8% to 24%) between 2000 and 2015. Most of the growth of this population can be explained by the increasing proportion of people that enrolled before 50 years and aged in care. These changes will impact needs of care for people living with HIV, due to multiple comorbidities and high risk of disability associated with aging.

Ecuadorian adolescents and cigarette smoking: a cross-sectional survey.

This study investigates adolescents' attitudes and behaviors toward cigarette smoking in Ecuador. Using social cognitive theory as a basis, the cross-sectional survey focuses attention on such social influences as the smoking habits of family members and peers, as well as on the role of cigarette advertisements. Data on prevalence of actual use, access to cigarettes, and knowledge and attitudes about smoking are also obtained. The survey was conducted during the summer of 1994 in both urban and rural areas. Fifty schools in 40 different communities participated, resulting in a sample of 2,625 adolescents aged 9 to 15 years who completed the self-administered questionnaire. This study was conducted in collaboration with Amigos de las Américas (AMIGOS), an international health organization. Staff and volunteers who participated in projects conducted by AMIGOS in Ecuador worked with local health and education officials to implement the survey. Nearly 9% of students identified themselves as current smokers, 24.5% had experimented with smoking, and 61.1% had never smoked. The results varied significantly by age and gender, with older students and boys smoking at the highest rate. The smoking status of family members and peers also significantly predicted student smoking status. The results from this sample replicate findings from North American samples. Although Ecuadorian students smoke somewhat less than their American counterparts, cigarette smoking in Ecuador is a significant public health problem and clearly warrants a coordinated response. The present study points to several strategies for preventing smoking among youth.