Background: Although Brazil has model HIV care programs, many patients continue to present late to care. We studied the frequency of tuberculosis (TB) diagnosed at HIV diagnosis in Rio de Janeiro, Brazil, in order to quantify missed opportunities for TB prevention.
Methods: People living with HIV (PLHIV) and enrolled in the TB/HIV in Rio (THRio) study between 1 September 2005 and 31 August 2009 were included. Prevalent TB was defined as TB diagnosed within 60 days of HIV diagnosis or HIV diagnosis during TB therapy. Survival was measured from HIV diagnosis. We conducted Kaplan-Meier survival plots and Cox regression analyses.
Results: 4,548 newly diagnosed PLHIV were enrolled; 476(10.5%) with prevalent TB. Prevalent TB cases were older, had lower CD4 counts and higher viral loads than those without TB. Median time to receiving highly active antiretroviral therapy (HAART) in prevalent TB cases was 99 days(IQR=58-191) vs. 126 days(IQR=63-301) in those without TB(p=0.021). Among prevalent TB cases, 17% died during follow-up compared to 8% among non-TB cases(p<0.001). After adjustment for sex, age, baseline CD4 and baseline viral load, risk of death remained significantly higher among prevalent TB cases[aHR=1.72(CI 95% 1.19-2.48)].
Conclusions: More than 10% of newly PLHIV in our study presented to care with concurrent active TB disease and thus missed the opportunity for TB preventive therapy. Despite initiating HAART more quickly, these were at significantly greater risk of death. Earlier HIV diagnosis is necessary to provide earlier initiation of HAART and TB preventive therapy to reduce morbidity and mortality in PLHIV.
(C) 2014 by Lippincott Williams & Wilkins