Epidemiological study and resistance patterns to the anti-tuberculosis drugs in mycobacteria and hiv co-infected patients in a reference hospital in Fortaleza, CearÃ

• Main Author: BrÃulio Matias de Carvalho
• Other Authors: Thalles Barbosa Granjeiro
• Format: Others
• Language: Portuguese
• Published: Universidade Federal do Cearà 2007
• Subjects: HIV; SÃndrome de ImunodeficiÃncia Adquirida; Mycobacterium tuberculosis; Tuberculosis; Risk Factors; Acquired Immunodeficiency Syndrome; DOENCAS INFECCIOSAS E PARASITARIAS
• Online Access: http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=2504

nÃo hà === The HIV infection and the tuberculosis (TB) are together the main causes of death for infectious agents in the world, being approximately 13 million people infected with both causative agents. The HIV-infected individuals show increased susceptibility for active tuberculosis, being the imunosupression caused by the virus the main risk factor for the development for active TB. This study investigated the profile of Mycobacterium tuberculosis drug resistance and evaluated the factors related to the development of TB in HIV infected patients who were treated at HSJ, which is a reference hospital in infectious diseases in Fortaleza, CearÃ, Brazil. During the period of July 2003 until June 2006, 208 patients with clinical and/or laboratorial diagnosis of micobacteriosis or tuberculosis and infection for the HIV were taken care in this hospital. The TB/HIV co-infected patients were older (average: 40 years, p= 0.0025) than the control group, being approximately 4 years older. The majority of the patients were male (80.8%, p= 0.0005) and they had shown a risk to develop TB of 43.0% greater compared to the female sex. The risk to develop the TB disease was two times higher in the patients with lower educational levels (less than eight years of schooling) and they represented 85.9% of the patients (p=0.000). The history of previous contact with TB patients and previous treatment for TB were also found to be risk factors for TB. The imunosupression level was higher in TB-HIV coinfected patients being the CD4+ lymphocytes count average of 169 cells/mm Â(p=0.000) and the viral load logarithm average of 4,36 (p=0.0013). The clinical forms most frequents were pulmonary (45.7%), extrapulmonary (28.4%) and disseminated (25.9%). Of the samples that were submitted to identification, 81.2% were M. tuberculosis and 12.8% were not M. tuberculosis. The resistance frequency to one drug and multi-resistance were the same (5.9%). Overall, these observations are important for establishing political strategies of public health to improve the conditions at the regional level. === A infecÃÃo pelo vÃrus HIV e a TB estÃo entre as principais causas de morte por agentes infecciosos no mundo, aproximadamente 13 milhÃes de pessoas estÃo infectadas com ambos agentes causadores. Os indivÃduos infectados pelo HIV apresentam susceptibilidade aumentada para tuberculose ativa, sendo a imunossupressÃo determinada pelo vÃrus o principal fator de risco para o desenvolvimento da doenÃa tuberculose. Este trabalho investigou o perfil de resistÃncia do Mycobacterium tuberculosis e os fatores epidemiolÃgicos relacionados ao desenvolvimento da doenÃa em pacientes co-infectados pelo HIV atendidos no Hospital SÃo Josà de DoenÃas Infecciosas (HSJ), o qual à referÃncia em doenÃas infecciosas em Fortaleza, Estado do CearÃ, Brasil. Foram analisados, no perÃodo de julho de 2003 atà junho de 2006, 208 pacientes com diagnÃstico clÃnico e/ou laboratorial de micobacteriose ou tuberculose e infecÃÃo pelo HIV atendidos no HSJ. Os pacientes co-infectados TB/HIV apresentavam idade superior aos pacientes do grupo controle (mÃdia de 40 anos, p= 0,0025), tendo aproximadamente 4 anos a mais. O sexo masculino apresentou maioria significante (80,8%, p= 0,0005) e teve risco 43,0% superior ao sexo feminino de desenvolver TB. O risco de adquirir TB foi duas vezes maior nos pacientes com escolaridade baixa, que representavam 85,9% dos pacientes (p=0,000). A histÃria de contato prÃvio com pacientes com TB e de tratamento prÃvio para TB foram considerados fatores de risco para TB nesta populaÃÃo. O nÃvel de imunossupressÃo foi maior nos pacientes co-infectados TBHIV com contagem mÃdia de linfÃcitos T CD4+ de 169 cels/mm (p=0,000), assim como o logaritmo da carga viral com mÃdia de 4,36 (p=0,0013). As formas clÃnicas mais freqÃentes foram: pulmonar (45,7%), extrapulmonar (28,4%) e disseminada (25,9%). Das amostras que foram realizadas identificaÃÃo, 81,2% foram identificadas como M. tuberculosis e 12,8% como nÃo M. tuberculosis. A freqÃÃncia de resistÃncia a uma droga e multi-resistÃncia foram iguais (5,9%). Esses resultados fornecem informaÃÃes importantes para o estabelecimento de estratÃgias de polÃticas de saÃde pÃblicas mais adequadas a nÃvel regional.