Perfil clínico-epidemiológico da coinfecção HIV/tuberculose em um serviço de assistência especializado em Belém/PA no período de 2011 a 2018

Abstract

The human immunodeficiency virus (HIV) is a retrovirus whose pathogenesis consists of an asymptomatic or symptomatic acute phase. If the patient is not treated, the disease may progress to acquired immunodeficiency syndrome (AIDS), considered a chronic and lethal infectious disease, and consequently the individual be susceptible to opportunistic infections. Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis and is one of the main causes of morbidity and mortality among people living with HIV/AIDS (PLHA). In Brazil, a prevalence of 8.1% of HIV/TB coinfection was reported in 2019, an average similar to that found in the state of Pará, with 9.1 % PLHA had co-infection with TB. The present study aims to describe the epidemiological profile of PLWHA with Tuberculosis (TB) in a Health Care Center for Acquired Infectious Diseases (CASA DIA) in the municipality of Belém, state of Pará, Brazil. This is an observational cross-sectional study based on the epidemiological method, carried out after the appraisal and release of opinion, which consisted of a collection of data from medical records and the Tuberculosis Program Book of PLHA coinfected with TB, aged over 18 years, who were monitored at CASA DIA in the municipality of Belém-PA from 2011 to 2018. Around of 598 medical records were analyzed, but only 366 were selected to compose the study following the inclusion and exclusion criteria. Among the 366 medical records, the mean age was 35.3 years, with a prevalence of 68.9% male and 80.6% of schooling corresponding to incomplete elementary school. The main behavioural risk factors for HIV infection that obtained prevalence were sexual orientation - heterosexual, with 48.6%, followed by 34.4% and 42.6% who reported having more than 3 sexual partners and who reported not using condoms during sexual intercourse. It was observed that 55.5% of patients had a detectable viral load and 49.2% had CD4+ lymphocytes <350 cells/mm3. In the clinical profile of tuberculosis, a prevalence of 64.5% was recorded for new cases, 35.8% for non-reactive (NR - <5mm) in the tuberculin skin test, 38.5% for a diagnosis suggestive of TB by chest X-ray, and 57.4% of the patients were diagnosed with pulmonary tuberculosis. Noting that about 37.2% completed the treatment, but 24.3% abandoned it. The correlation between the immunovirological profile and the clinical profile of TB did not present a statistically significant difference, but it was possible to observe that the detectable viral load had a higher incidence in both the pulmonary and extrapulmonary clinical forms, with 84% and 82%, respectively. It was also found that CD4+ values <350 cells/mm3 were higher in the clinical forms of TB, with 75% (104/139) for the pulmonary form and 74% for the extrapulmonary form. Thus, it is necessary to intensify educational, preventive and infection control measures. The study warns about the importance of filling out the medical records properly, to correct this filling failure, it is essential to train health professionals until they are able to complete the medical records.