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Diaz A, Diez M, Bleda MJ, Aldamiz M, Camafort M, Camino X, Cepeda C, Costa A, Ferrero O, Geijo P, Iribarren JA, Moreno S, Moreno ME, Labarga P, Pinilla J, Portu J, Pulido F, Rosa C, Santamaría JM, Telenti M, Trapiella L, Trastoy M, Viciana P. Eligibility for and outcome of treatment of latent tuberculosis infection in a cohort of HIV-infected people in Spain. BMC Infect Dis 2010; 10:267. [PMID: 20840743 PMCID: PMC2945350 DOI: 10.1186/1471-2334-10-267] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Accepted: 09/14/2010] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Previous studies have demonstrated the efficacy of treatment for latent tuberculosis infection (TLTBI) in persons infected with the human immunodeficiency virus, but few studies have investigated the operational aspects of implementing TLTBI in the co-infected population.The study objectives were to describe eligibility for TLTBI as well as treatment prescription, initiation and completion in an HIV-infected Spanish cohort and to investigate factors associated with treatment completion. METHODS Subjects were prospectively identified between 2000 and 2003 at ten HIV hospital-based clinics in Spain. Data were obtained from clinical records. Associations were measured using the odds ratio (OR) and its 95% confidence interval (95% CI). RESULTS A total of 1242 subjects were recruited and 846 (68.1%) were evaluated for TLTBI. Of these, 181 (21.4%) were eligible for TLTBI either because they were tuberculin skin test (TST) positive (121) or because their TST was negative/unknown but they were known contacts of a TB case or had impaired immunity (60). Of the patients eligible for TLTBI, 122 (67.4%) initiated TLTBI: 99 (81.1%) were treated with isoniazid for 6, 9 or 12 months; and 23 (18.9%) with short-course regimens including rifampin plus isoniazid and/or pyrazinamide. In total, 70 patients (57.4%) completed treatment, 39 (32.0%) defaulted, 7 (5.7%) interrupted treatment due to adverse effects, 2 developed TB, 2 died, and 2 moved away. Treatment completion was associated with having acquired HIV infection through heterosexual sex as compared to intravenous drug use (OR:4.6; 95% CI:1.4-14.7) and with having taken rifampin and pyrazinamide for 2 months as compared to isoniazid for 9 months (OR:8.3; 95% CI:2.7-24.9). CONCLUSIONS A minority of HIV-infected patients eligible for TLTBI actually starts and completes a course of treatment. Obstacles to successful implementation of this intervention need to be addressed.
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Affiliation(s)
- Asuncion Diaz
- Unidad de Epidemiología del VIH/SIDA, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Mercedes Diez
- Secretaria del Plan Nacional sobre el sida, Ministerio de Sanidad y Política Social, Madrid, Spain
| | - Maria Jose Bleda
- Unidad de Epidemiología del VIH/SIDA, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Mikel Aldamiz
- Servicio Medicina Interna, Hospital Txagorritxu,Vitoria, Spain
| | - Miguel Camafort
- Servicio Medicina Interna, Hospital Mora d'Ebre, Instituto de Investigación Sanitaria "Pere Virgili", Universidad "Rovira i Virgili", Mora d'Ebre, Spain
| | - Xabier Camino
- Servicio de Enfermedades Infecciosas, Hospital Ntra Sra de Aranzazu, San Sebastián, Spain
| | | | | | - Oscar Ferrero
- Servicio Enfermedades Infecciosas, Hospital de Basurto, Bilbao, Spain
| | - Paloma Geijo
- Servicio Medicina Interna, Hospital Virgen de la Luz, Cuenca, Spain
| | - Jose Antonio Iribarren
- Servicio de Enfermedades Infecciosas, Hospital Ntra Sra de Aranzazu, San Sebastián, Spain
| | - Santiago Moreno
- Servicio de Enfermedades Infeccciosas, Hospital Ramón y Cajal, Madrid, Spain
| | - Maria Elena Moreno
- Servicio de Enfermedades Infeccciosas, Hospital Ramón y Cajal, Madrid, Spain
| | - Pablo Labarga
- Servicio de Medicina Interna, Hospital San Millán, Logroño, Spain
| | - Javier Pinilla
- Servicio de Medicina Interna, Hospital San Millán, Logroño, Spain
| | - Joseba Portu
- Servicio Medicina Interna, Hospital Txagorritxu,Vitoria, Spain
| | | | - Carmen Rosa
- Servicio Medicina Interna, Hospital Virgen de la Luz, Cuenca, Spain
| | | | - Mauricio Telenti
- Unidad de Enfermedades Infecciosas, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Luis Trapiella
- Unidad de Enfermedades Infecciosas, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Monica Trastoy
- Servicio Enfermedades Infecciosas, Hospital Virgen del Rocío, Sevilla, Spain
| | - Pompeyo Viciana
- Servicio Enfermedades Infecciosas, Hospital Virgen del Rocío, Sevilla, Spain
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