Risk factors for unfavorable outcome of the disease in patients with HIV-associated tuberculosis
Abstract
To identify risk factor for unfavorable outcome of the disease in patients with HIV-associated tuberculosis the study including 459 cases of HIV-associated tuberculosis was conducted: 248 cases with an unfavorable outcome of the disease constituted the main group (MG) (186 males and 62 females, mean age 35.0 ± 1.5 years), the comparison group (CG) — 211 cases with a favorable outcome (160 males and 51 females; mean age — 37.0 ± 2.3 years). To assess the risk factors, the odds ratio (OR) and the 95% confidence interval in the binary logistic regression module were calculated.
The statistically significant risk factors for the unfavorable outcome of tuberculosis in HIV-infected patients are revealed: 1) risk factors associated with the peculiarities of the tubercular process — the presence of a widely extended, with the damage of two lung lobes and more, bilateral tubercular process, with lung tissue patholysis and the shedding of multidrug-resistant mycobacterium tuberculous to anti-tuberculous drugs, the generalization of tuberculosis with the lesion of 2 organs and more; 2) risk factors associated with characteristics of the course of HIV infection — the presence of immunodeficiency clinical signs, a comprehensive clinical picture of EBV (Epstein — Barr virus) infection, the intensity of the viral load is over 100 000 RNA copies HIV/ml, 3) a pre-term cessation of chemotherapy for tuberculosis, refusal of antiretroviral therapy, 4) Charlson comorbidity index > 8 points. The obtained results are the evidence of the need to reconsider the existing algorithms for the management of HIV-associated tuberculosis co-infected patients in terms of the identified risk factors for an unfavorable outcome of the disease.
About the Authors
O. G. Ivanova
Omsk State Medical University
Russian Federation
Russian Federation
Ivanova Olga Georgiyevna — Cand. Sci. (Med.), Associate Professor of the Phtysiatry, Phtysiosurgery and Infectious Diseases Department.
12, Lenina Str., Omsk, 644099
A. V. Mordyk
Omsk State Medical University
Russian Federation
Russian Federation
Mordyk Anna Vladimirovna — Dr. Sci. (Med.), Professor, Head of the Phtysiatry, Phtysiosurgery and Infectious Diseases Department
E. I. Krasnova
Novosibirsk State Medical University
Russian Federation
Russian Federation
Krasnova Elena Igorevna — Dr. Sci. (Med.), Professor, Head of the Infectious Diseases Department
References
1. World Health Organization Global Tuberculosis Report (2018). Retrieved on May 28, 2019 from http://who.int/tb/publications/global_report/en/.
2. Nechaeva O.B. (2017). Tuberculosis epidemic situation among HIV positive people in the Russian Federation. Tuberculosis and Lung Diseases, 95 (3), 13-19. In Russ.
3. Nechaeva O.B. (2017). Monitoring of tuberculosis and HIV-infection in the Russian Federation. Med. Alphabet, 3, 30 (327), 24-33.
4. Vasilyeva I.A., Belilovsky E.M., Borisov S.E., Ster-likov S.A. (2017). Multi drug resistant tuberculosis in the countries of the outer world and in the Russian Federation. Tuberculosis and Lung Diseases, 95 (11), 5-17. In Russ.
5. Tsybikova E.B., Punga V.V., Rusakova L.I. (2018). Tuberculosis with concurrent in Russia: statistics and correlations. Tuberculosis and Lung Diseases, 96 (12), 9-17.
6. Vasilyeva I.A., Belilovsky E.M., Borisov S.E. et al. (2017). Tuberculosis with concurrent HIV infection in the Russian Federation and the world. Tuberculosis and Lung Diseases, 95 (9), 8-18. In Russ.
7. Galkin V.B., Sterlikov S.A., Jarullina R.S. et al. (2017). Treatment outcomes in patients with tuberculosis, combined with HIV-infection. Med. Alliance, 4, 3043. In Russ.
8. About the improvement of antituberculosis actions in the Russian Federation: Order of the Ministry of Health of Russia of 21.03.2003. No. 109. Consul-tantPlus: Reference-legal system. Retrieved on May 5, 2019 from http://consultant.ru/document/cons_doc_LAW_100829. In Russ.
9. Kochetova E. (2018). Comprehensive assessment of patients with chronic obstructive pulmonary disease by means of multicomponent ADO index and Charlson comorbidity index. Med. Council, 12, 182184.
10. Federal Clinical Guidelines on Diagnostics and Treatment of Pulmonary Tuberculosis (2014). Moscow; Tver, 56 p. In Russ.
11. Federal Clinical Guidelines on Diagnostics and Treatment of Pulmonary Tuberculosis with Multiple and Wide Pathogen Resistance, 3rd ed. (2015). Retrieved on May 30, 2019 from http://roftb.ru/net-cat_files/doks2015/rec2.pdf. In Russ.
12. Khalaphyan A.A. (2007). STATISTICA 6. Data Statistical Analysis. 3rd ed. Moscow, 512 p. In Russ.
13. Maksimov S.A., Zinchuk S.F., Davydova E.A. et al. (2010). Risks and Their Evaluation in Medicobiologi-cal Studies. Methodological Recommendations. Kemerovo, 29 p. In Russ.
14. Everitt B.S. (2012). Big Dictionary of Statistics. Moscow, 736 p. In Russ.
15. Zimina V.N., Vasilyeva I.A., Batyrov F.A., Samoylova A.G. (2013). Chemotherapy efficiency in TB/HIV coinfected patients. Tuberculosis and Lung Diseases, 90 (3), 15-21.
16. Teklu A.M., Nega A., Mamuye A.T. et al. (2017). Factors associated with mortality of TB/HIV co-infected patients in Ethiopia. Ethiop. J. Health Sci., 27 (1), 29-38.
17. Magno E.D.S., Saraceni V., Sovza A.B. et al. (2017). Factors associated with TB/HIV coinfection: evidence from notification data in the State of Amazonas, Brazil, 2001-2012. Cad. Saude Publ., 33 (5), e: 00019315.
18. Adejumo O.A., Daniel O.J., Otesanya A.F. et al. (2017). Factors associated with TB/HIV co-infection among drug sensitive tuberculosis patients managed in a secondary health facility in Lagos, Nigeria. Afr. J. Infect. Dis., 11 (2), 75-82.
Review
For citations:
Ivanova O.G., Mordyk A.V., Krasnova E.I. Risk factors for unfavorable outcome of the disease in patients with HIV-associated tuberculosis. Journal of Siberian Medical Sciences. 2019;(3):33-43.
Views:
206
Email this article 