Immunosuppression level at AIDS and disseminated tuberculosis diagnosis in São Paulo State, Brazil
A.L.C.C. Toscano1,2, L.F. Jamal3, Â. Tayra3, M.C. Polon3, A. Gonçalves3
1STD/AIDS Reference and Training Center, Day-Hospital, São Paulo, Brazil, 2Emilio Ribas Infectious Diseases Institute, Day-Hospital, São Paulo, Brazil, 3STD/AIDS Reference and Training Center, São Paulo, Brazil
Background: Brazil is among countries with a large number of tuberculosis cases, as well as AIDS cases. Although the impact of HIV on tuberculosis mortality rates has decreased dramatically after the introduction of HAART (Highly Active Anti-retroviral Therapy), tuberculosis remains one of the leading causes of death among people living with HIV/AIDS. The aim of the present study is to describe the level of immunosuppression at the time of diagnosis of disseminated tuberculosis in São Paulo State, Brazil.
Methods: Patients diagnosed with AIDS and disseminated tuberculosis, extra-pulmonary, without cavitations (DTB) during the years 2007-2008 in São Paulo State-Brazil were selected at Notifiable Diseases Information System (SINAN). These results were linked to Control System for Laboratory Tests (SISCEL) database and the CD4 count cells collected closest to DTB diagnosis was obtained. Patients with other opportunistic infection at notification form were excluded. Age, gender and AIDS risk exposure factor informations were also collected.
Results: Six hundred and fifty-four patients were diagnosed with AIDS and DTB in 2007-2008. One hundred and forty-eight patients with other AIDS-defining conditions on notification form were excluded. Two hundred and sixty-eight patients had corresponding CD4 count in SISCEL; 62.3% had CD4 count < 200 cells/mm3 and 17.5% had CD4 count > 350 cells/mm3 at time of DTB diagnosis. Two hundred and seven patients (77.2%) were male and sixty-one female (22.6%). The mean age was 40 years-old for male and 41 years-old for female. The most frequent AIDS risk factor reported for DTB was heterosexual transmission.
Conclusions: The majority of DTB patients presented low CD4 count at time of diagnosis. However, patients without severe immunosupression were also found. The early detection of HIV infection may prevent the development of disseminated tuberculosis, with introduction of HAART and IPT (Isoniazid Preventive Therapy).
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