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Associated factors for treatment delay in pulmonary tuberculosis in HIV-infected individuals: a nested case-control study

Isabella Coimbra1*, Magda Maruza1, Maria de Fátima Pessoa Militão-Albuquerque2, Líbia Vilela Moura1, George Tadeu Nunes Diniz2, Demócrito de Barros Miranda-Filho3, Heloísa Ramos Lacerda1, Laura Cunha Rodrigues4 and Ricardo Arraes de Alencar Ximenes1

Author Affiliations

1 Post-graduation program in Tropical Medicine, Universidade Federal de Pernambuco, Rua Antonio Rabelo 245, Madalena, Recife, PE, CEP 50610-110, Brazil

2 The Ageu Magalhães Research Center, FIOCRUZ, Recife, Pernambuco, Brazil

3 Department of Clinical Medicine, Universidade de Pernambuco, Recife, Pernambuco, Brazil

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

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BMC Infectious Diseases 2012, 12:208  doi:10.1186/1471-2334-12-208

Published: 7 September 2012



The delay in initiating treatment for tuberculosis (TB) in HIV-infected individuals may lead to the development of a more severe form of the disease, with higher rates of morbidity, mortality and transmissibility. The aim of the present study was to estimate the time interval between the onset of symptoms and initiating treatment for TB in HIV-infected individuals, and to identify the factors associated to this delay.


A nested case-control study was undertaken within a cohort of HIV-infected individuals, attended at two HIV referral centers, in the state of Pernambuco, Brazil. Delay in initiating treatment for TB was defined as the period of time, in days, which was greater than the median value between the onset of cough and initiating treatment for TB. The study analyzed biological, clinical, socioeconomic, and lifestyle factors as well as those related to HIV and TB infection, potentially associated to delay. The odds ratios were estimated with the respective confidence intervals and p-values.


From a cohort of 2365 HIV-infected adults, 274 presented pulmonary TB and of these, 242 participated in the study. Patients were already attending 2 health services at the time they developed a cough (period range: 1 – 552 days), with a median value of 41 days. Factors associated to delay were: systemic symptoms asthenia, chest pain, use of illicit drugs and sputum smear-negative.


The present study indirectly showed the difficulty of diagnosing TB in HIV-infected individuals and indicated the need for a better assessment of asthenia and chest pain as factors that may be present in co-infected patients. It is also necessary to discuss the role played by negative sputum smear results in diagnosing TB/HIV co-infection as well as the need to assess the best approach for drug users with TB/HIV.

HIV; Tuberculosis; Delay