AUTHOR=Arriaga María B. , Araújo-Pereira Mariana , Barreto-Duarte Beatriz , Sales Caio , Miguez-Pinto João Pedro , Nogueira Evelyn B. , Nogueira Betânia M. F. , Rocha Michael S. , Souza Alexandra B. , Benjamin Aline , de Oliveira Jamile G. , Moreira Adriana S. R. , Queiroz Artur T. L. , Rodrigues Moreno M. S. , Spener-Gomes Renata , Figueiredo Marina C. , Durovni Betina , Cavalcante Solange , Lapa-e-Silva José R. , Kristki Afrânio L. , Cordeiro-Santos Marcelo , Sterling Timothy R. , Rolla Valeria C. , Andrade Bruno B. , the RePORT-Brazil consortium , Andrade Alice M. S. , Cubillos-Angulo Juan M. , Malta-Santos Hayna , Rebouças-Silva Jéssica , Santos Saulo R. N. , Ramos André , Costa Alysson G. , Silva Jaquelane , Gomes-Silva Adriano , Sant'Anna Flávia M. , Ignácio Francine P. , Nascimento Vanessa , Lourenço Maria Cristina , Silva Elisangela C. , Mello Mayla TITLE=Prevalence and Clinical Profiling of Dysglycemia and HIV Infection in Persons With Pulmonary Tuberculosis in Brazil JOURNAL=Frontiers in Medicine VOLUME=8 YEAR=2022 URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2021.804173 DOI=10.3389/fmed.2021.804173 ISSN=2296-858X ABSTRACT=Background

There are scarce data on the prevalence and disease presentation of HIV in patients with tuberculosis (TB) and dysglycemia (diabetes [DM] and prediabetes [PDM]), especially in TB-endemic countries.

Methods

We assessed the baseline epidemiological and clinical characteristics of patients with culture-confirmed pulmonary TB, enrolled in a multicenter prospective cohort in Brazil (RePORT-Brazil) during 2015–2019. Dysglycemia was defined by elevated glycated hemoglobin and stratified as PDM or DM. Additionally, we used data from TB cases obtained through the Brazilian National Notifiable Diseases Information System (SINAN), during 2015–2019. In SINAN, diagnosis of diabetes was based on self-report. Logistic regression models were performed to test independent associations between HIV, dysglycemia status, and other baseline characteristics in both cohorts.

Results

In the RePORT-Brazil cohort, the prevalence of DM and of PDM was 23.7 and 37.8%, respectively. Furthermore, the prevalence of HIV was 21.4% in the group of persons with TB-dysglycemia and 20.5% in that of patients with TBDM. In the SINAN cohort, the prevalence of DM was 9.2%, and among the TBDM group the prevalence of HIV was 4.1%. Logistic regressions demonstrated that aging was independently associated with PDM or DM in both the RePORT-Brazil and SINAN cohorts. In RePORT-Brazil, illicit drug use was associated with PDM, whereas a higher body mass index (BMI) was associated with DM occurrence. Of note, HIV was not associated with an increased risk of PDM or DM in patients with pulmonary TB in both cohorts. Moreover, in both cohorts, the TBDM-HIV group presented with a lower proportion of positive sputum smear and a higher frequency of tobacco and alcohol users.

Conclusion

There is a high prevalence of dysglycemia in patients with pulmonary TB in Brazil, regardless of the HIV status. This reinforces the idea that DM should be systematically screened in persons with TB. Presence of HIV does not substantially impact clinical presentation in persons with TBDM, although it is associated with more frequent use of recreational drugs and smear negative sputum samples during TB screening.