RESUMO
BACKGROUND: Tuberculosis (TB) and HIV are among the risk factors for deep vein thrombosis (DVT). There are several challenges in the management of DVT patients with TB-HIV co-infection including drug-drug interactions and non-adherence due to pill burden. METHODS: HIV infected patients starting treatment for TB were identified and followed up two weekly. Cases of DVT were diagnosed with Doppler ultrasound and patients were initiated on oral anticoagulation with warfarin and followed up with repeated INR measurements and warfarin dose adjustment. RESULTS: We describe 7 cases of TB and HIV-infected patients in Uganda diagnosed with DVT and started on anticoagulation therapy. Their median age was 30 (IQR: 27-39) years and 86 % were male. All patients had co-medication with cotrimoxazole, tenofovir, lamivudine and efavirenz and some were on fluconazole. The therapeutic range of the International Normalization Ratio (INR) was difficult to attain and unpredictable with some patients being under-anticoagulated and others over-anticoagulated. The mean Time in Therapeutic Range (TTR) for patients who had all scheduled INR measurements in the first 12 weeks was 33.3 %. Only one patient among those with all the scheduled INR measurements had achieved a therapeutic INR by 2 weeks. Four out of seven (57 %) of the patients had at least one INR above the therapeutic range which required treatment interruption. None of the patients had major bleeding. CONCLUSION: We recommend more frequent monitoring and timely dose adjustment of the INR, as well as studies on alternative strategies for the treatment of DVT in TB-HIV co-infected patients.
RESUMO
We report the outcome of investigations conducted in 73 human immunodeficiency virus (HIV) infected Ugandan adults presumed to have pulmonary tuberculosis (PTB). Following initial investigations, 32 of 73 patients were diagnosed with PTB. Of the remaining 41 patients initially classified as 'non-PTB', six had a delayed PTB diagnosis after a median of 6 weeks. Of the six patients lost to follow-up, four (66%) were reported to have died. Active tracking and close monitoring of HIV-infected patients presumed to have PTB independently of initial investigation results may reduce morbidity and mortality among this vulnerable patient group.
Nous rapportons le résultat d'investigations réalisées chez 73 adultes Ougandais positifs au virus de l'immunodéficience humaine (VIH) et présumés d'avoir une tuberculose pulmonaire (TBP). Après les investigations initiales, 32 de 73 patients ont eu un diagnostic de TBP. Sur les 41 patients restants initialement classés comme « pas de TBP ¼, six ont eu un diagnostic de TBP retardé après un délai médian de 6 semaines. Sur les six patients perdus de vue, quatre (66%) sont décédés. Une recherche active et un suivi rapproché des patients VIH positifs présumés d'avoir une TBP indépendamment des résultats des investigations initiales pourrait réduire la morbidité et la mortalité dans ce groupe de patients vulnérables.
En el presente artículo se comunican los resultados de las investigaciones realizadas en 73 adultos ugandeses aquejados de infección por el virus de la inmunodeficiencia humana (VIH), en quienes existía la presunción clínica de tuberculosis pulmonar (TBP). Tras los exámenes iniciales se emitió el diagnóstico de TBP en 32 de los 73 pacientes. De los 41 pacientes restantes, clasificados inicialmente 'sin TBP', este diagnóstico se estableció de manera tardía en seis de ellos y la mediana del plazo hasta el diagnóstico fue 6 semanas. Se notificó la defunción de cuatro de los seis pacientes perdidos de vista durante el seguimiento (66%). La localización activa y el seguimiento estrecho de los pacientes con infección por el VIH y presunción clínica de TBP, sea cual fuere el resultado de las investigaciones iniciales, disminuirían la morbilidad y mortalidad en este grupo de pacientes vulnerables.
