Tuberculosis treatment outcomes of diabetic and non-diabetic TB/HIV co-infected patients: A nationwide observational study in Brazil

Klauss Villalva-Serra; Beatriz Barreto-Duarte; Vanessa M Nunes; Rodrigo C Menezes; Moreno M S Rodrigues; Artur T L Queiroz; María B Arriaga; Marcelo Cordeiro-Santos; Afrânio L Kritski; Timothy R Sterling; Mariana Araújo-Pereira; Bruno B Andrade

doi:10.3389/fmed.2022.972145

Tuberculosis treatment outcomes of diabetic and non-diabetic TB/HIV co-infected patients: A nationwide observational study in Brazil

Front Med (Lausanne). 2022 Sep 16:9:972145. doi: 10.3389/fmed.2022.972145. eCollection 2022.

Authors

Klauss Villalva-Serra^{1

2}, Beatriz Barreto-Duarte^{1

3

4

5}, Vanessa M Nunes^{1

2}, Rodrigo C Menezes^{1

4

6

7}, Moreno M S Rodrigues^{1

8}, Artur T L Queiroz^{1

9}, María B Arriaga^{1

4

10}, Marcelo Cordeiro-Santos^{3

11

12}, Afrânio L Kritski^{5

13}, Timothy R Sterling¹⁴, Mariana Araújo-Pereira^{1

4

6

15}, Bruno B Andrade^{1

2

4

6

14

15}

Affiliations

¹ Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil.
² Curso de Medicina, Universidade Salvador (UNIFACS), Salvador, Brazil.
³ Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil.
⁴ Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil.
⁵ Programa de Pós-Graduação em Clínica Médica, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
⁶ Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil.
⁷ Grupo de Estudos em Medicina Intensiva (GEMINI), Salvador, Brazil.
⁸ Laboratório de Análise e Visualização de Dados, Fundação Oswaldo Cruz, Porto Velho, Brazil.
⁹ Center of Data and Knowledge Integration for Health, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil.
¹⁰ Instituto de Medicina Tropical Alexander Von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru.
¹¹ Fundação Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil.
¹² Faculdade de Medicina, Universidade Nilton Lins, Manaus, Brazil.
¹³ Programa Acadêmico de Tuberculose da Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
¹⁴ Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, United States.
¹⁵ Curso de Medicina, Faculdade de Ciência e Tecnologia (UNIFTC), Salvador, Brazil.

Abstract

Background: Tuberculosis (TB) is a worldwide public health problem, especially in countries that also report high numbers of people living with HIV (PLWH) and/or diabetes mellitus (DM). However, the unique features of persons with TB-HIV-DM are incompletely understood. This study compared anti-TB treatment (ATT) outcomes of diabetic and non-diabetic TB/HIV co-infected patients.

Methods: A nationwide retrospective observational investigation was performed with data from the Brazilian Tuberculosis Database System among patients reported to have TB-HIV co-infection between 2014 and 2019. This database includes all reported TB cases in Brazil. Exploratory and association analyses compared TB treatment outcomes in DM and non-DM patients. Unfavorable outcomes were defined as death, treatment failure, loss to follow-up or recurrence. Multivariable stepwise logistic regressions were used to identify the variables associated with unfavorable ATT outcomes in the TB-HIV population.

Results: Of the 31,070 TB-HIV patients analyzed, 999 (3.2%) reported having DM. However, in these TB-HIV patients, DM was not associated with any unfavorable treatment outcome [adjusted Odds Ratio (aOR): 0.97, 95% CI: 0.83-1.12, p = 0.781]. Furthermore, DM was also not associated with any specific type of unfavorable outcome in this study. In both the TB-HIV group and the TB-HIV-DM subpopulation, use of alcohol, illicit drugs and tobacco, as well as non-white ethnicity and prior TB were all characteristics more frequently observed in persons who experienced an unfavorable ATT outcome.

Conclusion: DM is not associated with unfavorable TB treatment outcomes in persons with TB-HIV, including death, treatment failure, recurrence and loss to follow up. However, consumption habits, non-white ethnicity and prior TB are all more frequently detected in those with unfavorable outcomes in both TB-HIV and TB-HIV-DM patients.

Keywords: Antiretroviral therapy (ART); HIV; diabetes; treatment outcome; tuberculosis.

Grants and funding

U01 AI069923/AI/NIAID NIH HHS/United States