INTRODUCCIÓN La tuberculosis es la segunda causa de muerte provocada por enfermedades infecciosas en el mundo, después del sida. En Cuba, la mayoría de los pacientes de tuberculosis tiene tuberculosis pulmonar y los indicadores de recuperación son elevados. Cuando la quimioterapia antituberculosa falla, el desenlace desfavorable más frecuente es la muerte.
OBJETIVO Determinar los patrones de supervivencia en una cohorte de pacientes de tuberculosis pulmonar en Cuba.
MÉTODOS Se efectuó un estudio de cohorte, retrospectivo, en pacientes aquejados de tuberculosis pulmonar que fueron notifi cados y tratados en Cuba durante 2009 y 2010. Se examinó el tiempo
transcurrido entre el diagnóstico y la muerte. La sobrevida de los pacientes se analizó con el estimador log-rank de Kaplan-Meier y se utilizó un modelo ajustado de Cox para analizar el riesgo de muerte.
RESULTADOS El estudio incluyó 1 339 pacientes de los cuales 71.7% se encontraban en edades de 25-65 años y 77.4% eran hombres. La forma más común fue la tuberculosis infecciosa pulmonar (75.6%).
Sólo un pequeño número de pacientes (5.7%) presentó coinfección TB/VIH. Se reportaron 94 muertes, 55% durante los primeros 60 días de tratamiento. Se encontraron índices inferiores de supervivencia
entre los hombres (HR 1.87, 95% IC 1.02–3.45), los pacientes coinfectados con HIV/sida (HR 6.25, 95% IC 3.46–11.31), y los pacientes de ≥48 años (HR 3.93, 95% IC 2.41–6.40).
CONCLUSIÓN El predominio de las muertes tempranas en el tratamiento de la tuberculosis puede estar relacionado con un diagnóstico o un tratamiento demorado. La mayor edad en el momento del diagnóstico, la pertenencia al sexo masculino y la coinfección con TB/VIH incrementa el riesgo de muerte.
PALABRAS CLAVE tuberculosis pulmonar, VIH/sida, mortalidad, supervivencia, casos fallecidos, Cuba

INTRODUCTION Tuberculosis is the second leading cause of infectious-disease death worldwide, after AIDS. Most tuberculosis patients in Cuba have pulmonary TB and recovery rates are high. When TB chemotherapy fails, the most common adverse outcome is death.

OBJECTIVE Determine survival patterns in a cohort of pulmonary TB patients in Cuba.

METHODS A retrospective cohort study was conducted of pulmonary TB patients who were notified and treated in Cuba in 2009 and 2010. Time elapsed between diagnosis and death was examined. Patient survival was analyzed with the Kaplan–Meier method and comparisons were made with the log-rank estimator; an adjusted Cox model was used to analyze risk of death.

RESULTS The study included 1339 patients, of whom 71.7% were aged 25–64 years and 77.4% were men. Infectious pulmonary tuberculosis was the most common form (75.6%). Only a small number of patients (5.7%) presented TB/HIV coinfection. Ninety-four deaths were reported, 55% during the first 60 days of treatment. Lower survival rates were observed among men (HR 1.87, 95% CI 1.02–3.45), patients coinfected with HIV/AIDS (HR 6.25, 95% CI 3.46–11.31), and patients aged ≥48 years (HR 3.93, 95% CI 2.41–6.40).

CONCLUSION The preponderance of deaths early in TB treatment course may be related to diagnostic and/or treatment delays. Older age at diagnosis, male sex and TB/HIV coinfection increase risk of death.

KEYWORDS Pulmonary tuberculosis, HIV/AIDS, mortality, survival, case fatality, Cuba

AIDS is a major cause of death in the Caribbean, a region with a high prevalence of HIV. However, prevalence in Cuba’s population aged 15 to 49 years, despite a slight increase in recent years, is considered extremely low (0.1%). At the close of 2010, 5692 Cuban patients were receiving antiretroviral therapy. SIDATRAT, an informatics system, was developed at the Pedro Kourí Tropical Medicine Institute in Havana to ensure proper monitoring and followup of drug administration. Functioning on a web platform utilizing an Apache server, PHP and MySQL, it records patients’ general information, CD4 counts, viral load and data from other laboratory tests, as well as endoscopic and imaging studies. It also compiles information on their AIDS classification, opportunistic infections, HIV subtype and resistance studies, followup consultations, drug regimen, adverse reactions to medications, changes in drug combinations, and survival; and tracks total number of individuals under treatment. SIDATRAT follows the client-server philosophy and enables access by authorized users throughout Cuba via the health informatics network. SIDATRAT has been found effective in supporting quality care for persons living with HIV/AIDS and universal access to antiretroviral therapy, compiling most of the information needed for decisionmaking on patient health and therapies. SIDATRAT has been offered to the UNDP office in Havana for sharing with other developing countries that may wish to adapt or implement it.