Aspectos relacionados ao tratamento da tuberculose e HIV/aids: abordagens qualitativa e quantitativa.

Abstract

Human immunodeficiency virus (HIV) infection represents a major challenge for tuberculosis (TB) control and the pharmacotherapy of both diseases is complex. This study aimed to evaluate the aspects related to TB and HIV/aids in the follow-up of coinfected patients. To achieve this end, it was methodologically organized in four articles: I- Analysis of survival and factors associated with the effectiveness of TB treatment in patients co-infected with HIV/AIDS in a cohort. II- Systematic review of the literature with meta-analysis on integrase inhibitors (INI). III- Integrative review of drug-related problems (DRP) in the pharmacotherapeutic follow-up of patients with TB, HIV/AIDS and co-infection. IV- Qualitative evaluation of the subjective experience with medication use and of the abandonment. In the cohort study carried out between January 2015 and December 2019 a total of 244 patients were followed up, of which 58.2% did not show effectiveness of the treatment, 12.3% died and 11.1% abandoned the treatment. Virological suppression at the beginning of TB treatment (HR=1,961, CI=1.123-3.422), previous use of antiretroviral therapy (HR=1.676, CI=1.060-2.651), not having previously treated tuberculosis (HR= 2.407, CI =1.197-3.501), not using illicit drugs (HR= 1.77, CI =1.14-2.72) and using the tuberculosis (HR=1.864, CI=1.084-3.205) were significant variables associated with cure according to Cox regression analysis. No statistical differences were identified between patients who used INI or others antiretrovirals regimens. In the systematic review with meta-analysis, there was no significant difference in efficacy, effectiveness and safety outcomes in the studies that evaluated efavirenz versus INI. In addition, the use of INI twice a day compromises adherence to treatment. The role of these drugs should be better determined by further studies of good methodological quality to assess their long-term efficacy, effectiveness and safety. The most frequent DRP identified through the integrative review were related to drug safety and indication. The studies reinforced that pharmaceutical intervention can reduce the number of DRP and increase the quality of patient care. For the qualitative study, interviews were carried out with 81 patients. In the thematic analysis of the medication experience, the experiences of adversity and socially constructed aspects were highlighted. Resolution is associated with the understanding of relief from signs and symptoms and health recovery, however, feelings of ambivalence permeate the others, which can lead to treatment abandonment. Once diagnosed with TB, timely and uninterrupted treatment, regardless of the antirretroviral therapy used, favors a favorable outcome, in addition to influencing behavioral factors, such as not using illicit drugs. As they are patients with specificities related to drug treatment, health professionals should pay special attention to the follow-up process.