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Interaction HIV/tuberculosis in Brazil: the first 15 years and the future.
Rodrigues LG; Castilho E; Chequer P; Fonseca MG; Loures L; Programa
January 30, 1997
Int Conf AIDS. 1996 Jul 7-12;11(1):167 (abstract no. Mo.C.1652). Unique

Objective: To examine the impact of tuberculosis (TB) in the morbidity /mortality of AIDS and mainly the impact of HIV in the incidence of TB in Brazil. Methods: Data from different national sources were evaluated: AIDS and TB case surveillance; HIV sentinel surveillance; mortality registers and special studies. In addition the future number of TB cases associated to HIV infection was estimated using EPIMODEL, a WHO model based upon a theorethical epidemic curve for AIDS empirical data. To make possible the use of EPIMODEL was adopted the assumption that all co-infected persons that progress to AIDS will develop TB. Results: (1) At the time of reporting 27% of the AIDS cases have already been diagnosed with TB. This proportion increases to 60% if one follows a cohort of HIV-infected persons. Taken into account the rapidly evolving HIV epidemic among young injecting drug users (IDU) in Brazil note that TB is more frequent in IDU-associated AIDS cases (26%) than in persons with AIDS transmitted through sexual intercourse (21%).(2) HIV infection is a risk factor for development of active TB in all the Brazilian regions. While it was observed a differential distribution of TB incidence among these regions, results from sentinel surveys showed homogenous distribution of HIV infection. Nowadays an increase in the TB mortality rates has been reported in cities with the highest AIDS incidence. Up to the end of this decade as many as 61000 new TB cases will occur nationwide as a result of HIV-associated immunodeficiency. Considering the current annual incidence of TB - 60000 cases - one can expected an excess of 14000 cases (25%) related to HIV in 1999. Conclusions: AIDS and TB Control Programs in Brazil should develop interprogram action. Aggressive prophylaxis for TB among HIV-infected persons and HIV testing and counseling for TB patients are important.