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Open Access Research article

Risk factors for default from tuberculosis treatment in HIV-infected individuals in the state of Pernambuco, Brazil: a prospective cohort study

Magda Maruza1*, Maria FP Militão Albuquerque2, Isabella Coimbra1, Líbia V Moura1, Ulisses R Montarroyos1, Demócrito B Miranda Filho3, Heloísa R Lacerda1, Laura C Rodrigues4 and Ricardo AA Ximenes13

Author Affiliations

1 Department of Tropical Medicine, Universidade Federal de Pernambuco, Recife, Brazil

2 NESC Department, Centro de Pesquisas Aggeu Magalhães/FIOCRUZ, Recife, Brazil

3 Department of Medical Science, Universidade de Pernambuco, Recife, Brazil

4 London School of Hygiene and Tropical Medicine, London, UK

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BMC Infectious Diseases 2011, 11:351  doi:10.1186/1471-2334-11-351

Published: 16 December 2011

Abstract

Background

Concomitant treatment of Human Immunodeficiency Virus (HIV) infection and tuberculosis (TB) presents a series of challenges for treatment compliance for both providers and patients. We carried out this study to identify risk factors for default from TB treatment in people living with HIV.

Methods

We conducted a cohort study to monitor HIV/TB co-infected subjects in Pernambuco, Brazil, on a monthly basis, until completion or default of treatment for TB. Logistic regression was used to calculate crude and adjusted odds ratios, 95% confidence intervals and P-values.

Results

From a cohort of 2310 HIV subjects, 390 individuals (16.9%) who had started treatment after a diagnosis of TB were selected, and data on 273 individuals who completed or defaulted on treatment for TB were analyzed. The default rate was 21.7% and the following risk factors were identified: male gender, smoking and CD4 T-cell count less than 200 cells/mm3. Age over 29 years, complete or incomplete secondary or university education and the use of highly active antiretroviral therapy (HAART) were identified as protective factors for the outcome.

Conclusion

The results point to the need for more specific actions, aiming to reduce the default from TB treatment in males, younger adults with low education, smokers and people with CD4 T-cell counts < 200 cells/mm3. Default was less likely to occur in patients under HAART, reinforcing the strategy of early initiation of HAART in individuals with TB.