Prevalence and characterization of human immunodeficiency virus coinfection in patients hospitalized with tuberculosis in a reference hospital in Bogotá
Abstract
Introduction. Tuberculosis is the leading cause of death in patients with human immunodeficiency virus infection; tuberculosis-HIV coinfection is highly prevalent.
Objective. To establish the prevalence of HIV infection in patients hospitalized with tuberculosis and determine their characteristics and outcomes.
Materials and methods. We conducted a retrospective cross-sectional study in patients diagnosed with pulmonary or extrapulmonary tuberculosis and HIV coinfection, hospitalized in a referral institution in Bogotá between 2019 and 2021.
Results. The prevalence of HIV infection in 102 patients with tuberculosis was 52.3% (54/102). Among them, 24 patients (44.4%) had microbiological or histopathological confirmation of tuberculosis infection; and 19 (35.2%) were recently diagnosed with an HIV infection. The median age of the 54 coinfected patients was 38 years (IQR: 29-42); 79.6% (43/54) were men. The median CD4+ T-cell count was 59 cells/μL (IQR: 32-120), and 72.2% (39/54) had a CD4+ count of less than 200 cells/μL; 31.4% (17/54) of patients with a history of HIV infection were receiving antiretroviral therapy. Regarding tuberculosis clinical presentation, 51.9% (28/54) had pulmonary tuberculosis, and 48.1% (26/54) had
extrapulmonary tuberculosis. The extrapulmonary tuberculosis forms were meningeal (29.6%), miliary (12.9%), pleural (3.7%), and peritoneal (3.7%). The in-hospital mortality was 33.3%, associated with a low CD4+ count (p < 0.05), recent HIV diagnosis (p < 0.04), and the presence of meningeal tuberculosis (p < 0.03).
Conclusion. The frequency of tuberculosis-HIV coinfection is high and related to an advanced degree of immunosuppression. Therefore, we recommend an active search for coinfection. Meningeal tuberculosis was the most frequent extrapulmonary form and was associated with mortality.
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References
1. Murray CJL, Ortblad KF, Guinovart C, Lim SS, Wolock TM, Roberts DA, et al. Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990-2013: A systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384:1005-70. https://doi.org/10.1016/S0140-6736(14)60844-8
2. Deeks SG, Overbaugh J, Phillips A, Buchbinder S. HIV infection. Nat Rev Dis Primers. 2015;1:15035. https://doi.org/10.1038/nrdp.2015.35
3. Pawlowski A, Jansson M, Sköld M, Rottenberg ME, Källenius G. Tuberculosis and HIV coinfection. PLoS Pathog. 2012;8:1002464. https://doi.org/10.1371/journal.ppat.1002464
4. World Health Organization (WHO). Global tuberculosis report 2024. Geneva: World Health Organization; 2024. Fecha de consulta: 18 de febrero de 2025. Disponible en: https://iris.who.int/bitstream/handle/10665/379339/9789240101531-eng.pdf?sequence=1
5. Letang E, Ellis J, Naidoo K, Casas EC, Sánchez P, Hassan-Moosa R, et al. Tuberculosis-HIV co-infection: Progress and challenges after two decades of global antiretroviral treatment roll-out. Arch Bronconeumol. 2020;56:446-54. https://doi.org/10.1016/j.arbr.2019.11.013
6. Gray JM, Cohn DL. Tuberculosis and HIV coinfection. Semin Respir Crit Care Med. 2013;34:32-43. https://doi.org/10.1055/s-0032-1333469
7. Edge CL, King EJ, Dolan K, McKee M. Prisoners co-infected with tuberculosis and HIV: A systematic review. J Int AIDS Soc. 2016;19:20960. https://doi.org/10.7448/IAS.19.1.20960
8. Bell LCK, Noursadeghi M. Pathogenesis of HIV-1 and Mycobacterium tuberculosis coinfection. Nat Rev Microbiol. 2018;16:80-90. https://doi.org/10.1038/nrmicro.2017.128
9. Mesfin YM, Hailemariam D, Biadgilign S, Kibret KT. Association between HIV/AIDS and multi-drug resistance tuberculosis: A systematic review and meta-analysis. PLoS ONE. 2013;8:e82235. https://doi.org/10.1371/journal.pone.0082235
10. Rockwood N, Wilkinson RJ. Understanding and intervening in HIV-associated tuberculosis. Clin Med (Lond). 2015;15(Suppl.6):S43-9. https://doi.org/10.7861/clinmedicine.15-6-s43
11. Fadul-Pérez S. Protocolo de Vigilancia de Tuberculosis. Instituto Nacional de Salud. 2022. p.1-33. Fecha de consulta: 13 de junio de 2024. Disponible en: https://www.ins.gov.co/buscador-eventos/Lineamientos/Pro_Tuberculosis%202022.pdf
12. Pan American Health Organization. Factsheet 2022: TB/HIV co-infection in the Americas. Washington D. C.: PAHO/WHO; 2022. Fecha de consulta: 18 de febrero de 2025. Disponible en: https://www.paho.org/sites/default/files/2023-08/2022-cde-factsheet-tb-HIVamericas.pdf
13. Ministerio de Salud y Protección Social. Lineamiento técnico operativo del Programa Nacional de Tuberculosis. Dirección de Promoción y Prevención. Subdirección de Enfermedades Transmisibles. Bogotá, D.C.; 2020. Fecha de consulta: 13 de junio de 2024. Disponible en: https://www.minsalud.gov.co/Normatividad_Nuevo/Resoluci%C3%B3n%20No.%20227%20de%202020.pdf
14. StataCorp. Stata Statistical Software: Release 15. College Station, Texas: StataCorp; 2017.
15. Ministerio de Salud. Resolución número 8430 de 1993 por la cual se establecen las normas científicas, técnicas y administrativas para la investigación en salud. 1993. Fecha de consulta: 13 de junio de 2024. Disponible en: https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/DE/DIJ/RESOLUCION-8430-DE-1993.pdf
16. Frieden TR, Harold Jaffe DW, Moran JS, Leahy MA, Martinroe JC, Spriggs SR, et al. Revised surveillance case definition for HIV Infection — United States, 2014. MMWR Recomm Rep. 2014;63:1-13.
17. Joint United Nations Programme on HIV/AIDS (UNAIDS). In danger: UNAIDS Global AIDS Update 2022. Geneva: UNAIDS; 2022. Fecha de consulta: 13 de junio de 2024. Disponible en: https://www.unaids.org/sites/default/files/media_asset/2022-global-aids-update_en.pdf
18. Kawatsu L, Uchimura K, Kaneko N, Imahashi M. Epidemiology of coinfection with tuberculosis and HIV in Japan, 2012-2020. West Pac Surveill Response J. 2022;13:1-8. https://doi.org/10.5365/wpsar.2022.13.1.896
19. Zohar M, Moshe L, Daniel C, Noa C, Itamar G. HIV prevalence in the Israeli tuberculosis cohort, 1999-2011. BMC Public Health. 2014;14:1090. https://doi.org/10.1186/1471-2458-14-1090
20. WHO Regional Office for Europe, European Centre for Disease Prevention and Control. HIV/AIDS surveillance in Europe 2024-2023 data. Copenhagen: WHO Regional Office for Europe; 2024. Fecha de consulta: 18 de febrero de 2025. Disponible en: https://www.ecdc.europa.eu/sites/default/files/documents/HIV_Surveillance_Report_2024.pdf
21. Cuenta de Alto Costo (CAC). Situación del HIV en Colombia 2024; Bogotá, D. C.: Fondo Colombiano de Enfermedades de Alto Costo; 2025. Fecha de consulta: 18 de febrero de 2025. Disponible en: https://cuentadealtocosto.org/publicaciones/situacion-del-HIV-encolombia-2024/
22. Cortés JA, Hidalgo P, Rey DL, Parra GA, Gutiérrez IF. Tuberculosis en pacientes con infección por VIH en el Hospital Universitario de San Ignacio, 2002-2006. Infectio. 2007;11:16-22.
23. Ruiz L, Maya MA, Rueda ZV, López L, Vélez LA. Current characteristics of tuberculosis and human immunodeficiency virus co-infection in a cohort of hospitalized patients in Medellín, Colombia. Biomédica. 2018;38:59-67. https://doi.org/10.7705/biomedica.v38i3.3862
24. Tancredi MV, Sakabe S, Waldman EA. Mortality and survival of tuberculosis coinfected patients living with AIDS in São Paulo, Brazil: A 12-year cohort study. BMC Infect Dis. 2022;22:223. https://doi.org/10.1186/s12879-022-07232-6
25. Sanhueza-Sanzana C, Kerr L, Kendall C. Mortality from AIDS and tuberculosis-HIV coinfection in the Chilean AIDS Cohort of 2000-2017. Cad Saúde Pública. 2021;37:e00212920. https://doi.org/10.1590/0102-311X00212920
26. García I, Merchán A, Chaparro PE, López LE. Panorama de la coinfección tuberculosis/HIV en Bogotá, 2001. Biomédica. 2004;24(Supl.1):132-7. https://doi.org/10.7705/biomedica.v24iSupp1.1312
27. Montúfar Andrade FE, Villa Franco P, Montúfar Pantoja MC, Zuleta Tobón JJ, Pérez Jaramillo LE, Monsalve Valencia MA, et al. Coinfección por virus de inmunodeficiencia humana y micobacterias en un hospital universitario de alta complejidad en Colombia. Infectio. 2016;20:158-64. http://doi.org/10.1016/j.infect.2015.05.004
28. Joint United Nations Programme on HIV/AIDS (UNAIDS). Global HIV & AIDS statistics — Fact sheet 2024. Geneva: UNAIDS; 2024. Fecha de consulta: 19 de febrero de 2025. Disponible en: https://www.unaids.org/sites/default/files/media_asset/UNAIDS_FactSheet_en.pdf
29. de Vries G, van de Berg S, van Dam A, Hasanova S, Pareek M, van der Werf MJ, et al. Collaborative tuberculosis/HIV activities in the European Region. ERJ Open Res. 2021;7:00721-2020. https://doi.org/10.1183/23120541.00721-2020
30. Abay SM, Deribe K, Reda AA, Biadgilign S, Datiko D, Assefa T, et al. The Effect of early initiation of antiretroviral therapy in TB/HIV-coinfected patients: A systematic review and meta-analysis. J Int Assoc Provid AIDS Care. 2015;14:560-70. https://doi.org/10.1177/2325957415599210
31. Plata-Casas L, Gutiérrez-Lesmes O, Herrán-Falla O. Infección concomitante por tuberculosis y el virus de la inmunodeficiencia humana: situación epidemiológica e departamento del Meta, 2010-2015. Biomédica. 2018;38:68-79. https://doi.org/10.7705/biomedica.v38i3.3930
32. Rindi L. Rapid molecular diagnosis of extra-pulmonary tuberculosis by Xpert/RIF ultra. Front Microbiol. 2022;13:817661. https://doi.org/10.3389/fmicb.2022.817661
33. Seddon JA, Tugume L, Solomons R, Prasad K, Bahr NC; Tuberculous Meningitis International Research Consortium. The current global situation for tuberculous meningitis: Epidemiology, diagnostics, treatment and outcomes. Wellcome Open Res. 2019;4:167. https://doi.org/10.12688/wellcomeopenres.15535.1
34. Cecchini D, Ambrosioni J, Brezzo C, Corti M, Rybko A, Pérez M, et al. Tuberculous meningitis in HIV-infected and non-infected patients: Comparison of cerebrospinal fluid findings. Int J Tuberc Lung Dis. 2009;13:269-71.
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