Pesquisa | SciELO

RESUMO OBJETIVO Estimar a incidência de HIV em dois municípios brasileiros, Recife e Curitiba, no ano de 2013. MÉTODOS O método de estimação da incidência foi baseado em informações primárias, resultantes do ensaio laboratorial Lag-Avidity para detecção de infecções recentes do HIV, aplicado em uma amostra dos casos diagnosticados nas duas cidades em 2013. Para a estimação da incidência de HIV para a população total das cidades, as infecções recentes detectadas na pesquisa foram anualizadas e ponderadas pelo inverso da probabilidade de teste de HIV no ano de 2013 entre os casos infectados e não diagnosticados. Após a estimação da incidência de HIV para a população total, foram estimadas as taxas de incidência por sexo, faixa de idade e categoria de exposição. RESULTADOS Em Recife, foram diagnosticados 902 indivíduos de 13 anos e mais com infecção de HIV. Desses, 528 foram incluídos no estudo, e a proporção estimada de infecções recentes foi de 13,1%. Em Curitiba, foram diagnosticadas 1.013 pessoas de 13 anos e mais, 497 participaram do estudo, e a proporção de infecções recentes foi de 10,5%. Em Recife, a taxa de incidência estimada foi de 53,1 por 100 mil habitantes de 13 anos e mais, enquanto em Curitiba, de 41,1 por 100 mil, com razão do sexo masculino para o feminino de 3,5 e 2,4, respectivamente. Foram evidenciadas elevadas taxas de incidência de HIV entre homens que fazem sexo com homens, de 1,47% em Recife e 0,92% em Curitiba. CONCLUSÕES Os resultados obtidos nas duas cidades mostraram que o grupo dos homens que fazem sexo com homens está desproporcionalmente sujeito ao maior risco de novas infecções, e indicam que estratégias para controle da disseminação da epidemia nesse subgrupo populacional são essenciais e urgentes.

ABSTRACT OBJECTIVE To estimate HIV incidence in two Brazilian municipalities, Recife and Curitiba, in the year of 2013. METHODS The method for estimating incidence was based on primary information, resulting from the Lag-Avidity laboratory test for detection of recent HIV infections, applied in a sample of the cases diagnosed in the two cities in 2013. For the estimation of the HIV incidence for the total population of the cities, the recent infections detected in the research were annualized and weighted by the inverse of the probability of HIV testing in 2013 among the infected and not diagnosed cases. After estimating HIV incidence for the total population, the incidence rates were estimated by sex, age group, and exposure category. RESULTS In Recife, 902 individuals aged 13 years and older were diagnosed with HIV infection. From these, 528 were included in the study, and the estimated proportion of recent infections was 13.1%. In Curitiba, 1,013 people aged 13 years and older were diagnosed, 497 participated in the study, and the proportion of recent infections was 10.5%. In Recife, the estimated incidence rate was 53.1/100,000 inhabitants of 13 years and older, while in Curitiba, it was 41.1/100,000, with male-to-female ratio of 3.5 and 2.4, respectively. We observed high rates of HIV incidence among men who have sex with men, of 1.47% in Recife and 0.92% in Curitiba. CONCLUSIONS The results obtained in the two cities showed that the group of men who have sex with men are disproportionately subject to a greater risk of new infections, and indicate that strategies to control the spread of the epidemic in this population subgroup are essential and urgent.

https://doi.org/10.1590/S1518-8787.2016050006310 546 downloads

Estimation of HIV incidence in two Brazilian municipalities, 2013
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Szwarcwald, Célia Landmann

; Ferreira Júnior, Orlando da Costa

; Brito, Ana Maria de

; Luhm, Karin Regina

; Ribeiro, Clea Elisa Lopes

; Silva, Ana Maria

; Cavalcanti, Ana Maria Salustiano

; Ito, Tomoko Sasazawa

; Raboni, Sonia Mara

; Souza Júnior, Paulo Roberto Borges de

; Pereira, Gerson Fernando Mendes

Revista de Saúde Pública

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2016, Volume 50 elocation 55

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

https://doi.org/10.1590/S1518-8787.2016050006310 2890 downloads

HIV-1 incidence among people seeking voluntary counseling and testing centers, including pregnant women, in Pernambuco State, Northeast Brazil
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Lima, Kledoaldo Oliveira de

; Salustiano, Daniela Medeiros

; Cavalcanti, Ana Maria Salustiano

; Leal, Élcio de Souza

; Lacerda, Heloísa Ramos

Cadernos de Saúde Pública

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Jun 2015, Volume 31 Nº 6 Páginas 1327 - 1331

Resumo: Pt En Es | Texto: Pt En Es | PDF: Pt | PDF: En | PDF: Es

No Brasil, a epidemia do HIV-1 adquiriu novas características ao longo do tempo, como o aumento da transmissão heterossexual e um declínio da razão homens:mulheres em casos de AIDS. Foi oferecida triagem para a infecção pelo HIV a todos os pacientes atendidos no Centro de Testagem e Aconselhamento da cidade de Paulista, Região Metropolitana de Recife, Pernambuco, Nordeste do Brasil, com o objetivo de determinar a incidência do HIV-1. Foi usado o enzimaimunoensaio de captura BED (BED-CEIA) para determinar a incidência do HIV-1, comparando-o com o método de índice de avidez AxSYM (Ax-AI). No período analisado, 2006-2009, 14.014 pessoas foram testadas, e apenas 18 gestantes foram diagnosticadas para a infecção por HIV, resultando em uma incidência de 0,15% ao ano (IC95%: 0,00-0,33), significativamente menor do que os homens (1,03; IC95%: 0,45-1,61) e mulheres não-grávidas (0,50; IC95%: 0,11-0,89). Apesar da baixa incidência de HIV-1 entre as mulheres grávidas, a alta taxa de infecção recente reforça cuidados no pré-natal para esta infecção, para evitar a transmissão vertical.

The HIV-1 epidemic in Brazil has displayed new characteristics over time, with an increase in heterosexual transmission and a decline in the male-to-female ratio in AIDS cases. HIV screening was offered to patients attending the Voluntary Counseling and Testing Center in Paulista, Greater Metropolitan Recife, Pernambuco State, in Northeast Brazil, to determine HIV-1 incidence. BED capture enzyme immunoassay (BED-CEIA) was used to measure HIV-1 incidence, comparing it to the AxSYM avidity index method (Ax-AI). From 2006 to 2009, 14,014 individuals were tested, and only 18 pregnant women were diagnosed with HIV infection, resulting in 0.15% annual incidence (95%CI: 0-0.33), significantly lower than in men (1.03; 95%CI: 0.45-1.61) and non-pregnant women (0.50; 95%CI: 0.11-0.89). Despite the low HIV-1 incidence in pregnant women, the high rate of recent infection detected during prenatal care emphasizes the need to increase measures to prevent vertical transmission.

En Brasil, epidemia del VIH-1 adquiere nuevas características con tiempo, como el aumento de la transmisión heterosexual y disminución de la razón hombres:mujeres en los casos de SIDA. La detección de infección por VIH se ofrece a todos los pacientes que acuden al Centro de Asesoramiento y Pruebas (CTA) en la ciudad de Paulista, área metropolitana de Recife, noreste - Brasil, con objetivo de determinar la incidencia del VIH-1. BED inmunoensayo enzimático de captura (BED-CEIA) se utilizó para determinar la incidencia de VIH-1, comparándolo con el método del índice de avidez AxSYM (AX AI). En el período de 2006-2009, 14.014 personas se pusieron a prueba, 18 mujeres embarazadas fueron diagnosticados con infección por VIH, com incidencia de 0.15% anual (IC95%: 0-0.33), inferior a los hombres (1.03; IC95%: 0.45-1.61) y las mujeres no embarazadas (0.50; IC95%: 0.11-0.89). A pesar de la baja incidencia de VIH-1 en las mujeres embarazadas, alta tasa de infección reciente aumenta en la atención prenatal para esta infección para prevenir la transmisión vertical.

https://doi.org/10.1590/0102-311X00186813 1797 downloads

HIV-1 incidence among people seeking voluntary counseling and testing centers, including pregnant women, in Pernambuco State, Northeast Brazil
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Lima, Kledoaldo Oliveira de

; Salustiano, Daniela Medeiros

; Cavalcanti, Ana Maria Salustiano

; Leal, Élcio de Souza

; Lacerda, Heloísa Ramos

Cadernos de Saúde Pública

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Jun 2015, Volume 31 Nº 6 Páginas 1327 - 1331

Resumo: Pt En Es | Texto: Pt En Es | PDF: Pt | PDF: En | PDF: Es

https://doi.org/10.1590/0102-311X00186813 801 downloads

Comparison among the BED capture enzyme immunoassay test and AxSYM avidity index assay for determining recent HIV infection and incidence in two Voluntary Counselling and Testing Centres in Northeast Brazil
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Salustiano, Daniela Medeiros

; Lima, Kledoaldo Oliveira de

; Cavalcanti, Ana Maria Salustiano

; Diaz, Ricardo Sobhie

; Lacerda, Heloisa Ramos

Brazilian Journal of Infectious Diseases

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Ago 2014, Volume 18 Nº 4 Páginas 449 - 453

Resumo: En | Texto: En | PDF: En

The aims of this study were to compare the automated AxSYM avidity assay index with the BED capture enzyme immunoassay test and to calculate the HIV-1 incidence using the BED capture enzyme immunoassay and AxSYM avidity assay index algorithms within a population seeking the Voluntary Counselling and Testing Centres in two municipalities in the Metropolitan Region of Recife, Northeast of Brazil. An analysis was conducted in 365 samples that tested positive for HIV infection from frozen serum collected during the period 2006-2009. There was a similar proportion of males and females; most patients were heterosexual (86%) with a median age of 29 years. Of the 365 samples, 102 (28%) and 66 (18.1%) were identified as recent infections by BED capture enzyme immunoassay and AxSYM avidity assay index, respectively. The HIV-1 total incidence in the BED capture enzyme immunoassay and AxSYM avidity assay index algorithms were: 0.79 (95% CI: 0.60-0.98) and 0.34 (95% CI: -0.04 to 0.72), respectively. Incidence was higher among men. There was good agreement between the tests, with a kappa of 0.654 and a specificity of 95.8%. AxSYM avidity assay index may be helpful in improving the quality of the estimates of recent HIV infection and incidence, particularly when used in a combined algorithm with BED capture enzyme immunoassay.

https://doi.org/10.1016/j.bjid.2014.03.001 898 downloads

Primary resistance of HIV to antiretrovirals among individuals recently diagnosed at voluntary counselling and testing centres in the metropolitan region of Recife, Pernambuco
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Cavalcanti, Ana Maria Salustiano

; Brito, Ana Maria de

; Salustiano, Daniela Medeiros

; Lima, Kledoaldo Oliveira de

; Silva, Sirleide Pereira da

; Diaz, Ricardo Sobhie

; Lacerda, Heloisa Ramos

Memórias do Instituto Oswaldo Cruz

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Jun 2012, Volume 107 Nº 4 Páginas 450 - 457

Resumo: En | Texto: En | PDF: En

Determining the prevalence and type of antiretroviral (ARV) resistance among ARV-naïve individuals is important to assess the potential responses of these individuals to first-line regimens. The prevalence of primary resistance and the occurrence of recent infections among individuals with human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) were identified among recently diagnosed patients at five sexually transmitted disease/AIDS testing and counselling centres in the metropolitan region of Recife (RMR), Pernambuco, Brazil, between 2007-2009. One-hundred and eight samples were analysed using the Calypte® BED assay. Males predominated (56%), as did patients aged 31-50 years. Twenty-three percent presented evidence of a recent HIV infection. The median CD4+ T lymphocyte count was 408 cells/mm³ and the median viral load was 3.683 copies/mL. The prevalence of primary resistance was 4.6% (confidence interval 95% = 1-8.2%) based on criteria that excluded common polymorphisms in accordance with the surveillance drug resistance mutation criteria. The prevalence of resistance to non-nucleoside reverse transcriptase, nucleoside/nucleotide reverse transcriptase and protease inhibitors were 3.8%, 1.5% and 0.8%, respectively. Fifty-seven percent of strains were from clade B, 37.7% were clade F and 3.1% were clade C; there were no statistically significant differences with respect to resistance between clades. Recent infection tended to be more common in men (p = 0.06) and in municipalities in the south of the RMR (Jaboatão dos Guararapes and Cabo de Santo Agostinho) (p = 0.046). The high prevalence of recent infection and the high prevalence of non-B strains in this poor Brazilian region merit further attention.

2623 downloads

Recent HIV infection rates among HIV positive patients seeking voluntary counseling and testing centers in the metropolitan region of Recife - Pe, Brazil
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Cavalcanti, Ana Maria Salustiano

; Brito, Ana Maria de

; Salustiano, Daniela Medeiros

; Lima, Kledoaldo Oliveira de

; Silva, Sirleide Pereira da

; Lacerda, Heloisa Ramos

Brazilian Journal of Infectious Diseases

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Abr 2012, Volume 16 Nº 2 Páginas 157 - 163

Resumo: En | Texto: En | PDF: En

The BED capture enzyme immunoassay test makes it possible to determine whether individuals were recently infected with HIV. OBJECTIVE: In this study, the overall HIV and recent infections prevalences were determined at five Voluntary Counseling and Testing (VCT) centers, in the Metropolitan Region of Recife, Northeastern of Brazil. MATERIAL AND METHODS: A cross-sectional study was conducted among users of five VCTs in the metropolitan region of Recife between July 2007 and April 2009. Out of the individuals who tested positive for HIV, 169 were analyzed to assess the prevalence of recent infection by means of the BED-CEIA (BED-Calypte®). RESULTS: Out of 46,696 individuals tested 916 (1.96%) turned out positive for HIV infection The highest prevalence was in Recife (3.9%). The prevalence was higher among males (3.93%), and men who have sex with men (MSM) (12.4%). The frequency of recent infections among the 169 subjects evaluated was 23.7%. Recent infections were more common among individuals under 25 years of age. There was slight predominance of men and higher frequency of heterosexuals in both groups, but still a significant portion of MSM (33%). Subtype B predominated, followed by a high proportion of subtype F. CONCLUSIONS: Recent infection occurs mainly among young individuals and heterosexuals, despite a significant proportion of recent infection among MSM. These results suggest that preventive actions aimed at the MSM community remains a challenge and efforts focusing this group should continue to be a priority.

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Frequency of HLA B*5701 allele carriers in abacavir treated-HIV infected patients and controls from northeastern Brazil
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Crovella, Sergio

; Biller, Lara

; Santos, Sergio

; Salustiano, Ana

; Brandao, Lucas

; Guimaraes, Rafael

; Segat, Ludovica

; Lima Filho, Jose Luiz de

; Arraes, Luiz Claudio

Clinics

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2011, Volume 66 Nº 8 Páginas 1485 - 1488

Resumo: En | Texto: En | PDF: En

2532 downloads Citado 3 vezes em SciELO

10.

Antiretroviral resistance in individuals presenting therapeutic failure and subtypes of the human immunodeficiency virus type 1 in the Northeast Region of Brazil
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Cavalcanti, Ana Maria Salustiano

; Lacerda, Heloisa Ramos

; Brito, Ana Maria de

; Pereira, Sirleide

; Medeiros, Daniela

; Oliveira, Suelene

Memórias do Instituto Oswaldo Cruz

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Nov 2007, Volume 102 Nº 7 Páginas 785 - 792

Resumo: En | Texto: En | PDF: En

This study aimed to analyze human immunodeficiency virus (HIV) mutation profiles related to antiretroviral resistance following therapeutic failure, and the distribution of hiv subtypes in the Northeast Region of Brazil. A total of 576 blood samples from AIDS patients presenting therapeutic failure between 2002 and 2004 were analyzed. The genotyping kit viroSeq® was used to perform viral amplification in order to identify mutations related to hiv pol gene resistance. An index of 91.1% of the patients presented mutations for nucleoside reverse transcriptase inhibitors (nrti), 58.7% for non-nucleoside reverse transcriptase inhibitors (nnrti), and 94.8% for protease inhibitors (pi). The most prevalent mutations were 184V and 215E for nrti, 103N and 190A for nnrti. Most mutations associated with PIs were secondary, but significant frequencies were observed in codons 90 (25.2%), 82 (21.1%), and 30 (16.2%). The resistance index to one class of antiretrovirals was 14%, to two classes of antiretrovirals 61%, and to three classes 18.9%. Subtype B was the most prevalent (82.4%) followed by subtype F (11.8%). The prevalence of mutations related to nrti and nnrti was the same in the two subtypes, but codon analysis related to PI showed a higher frequency of mutations in codon 63 in subtype B and in codon 36 in subtype F. The present study showed that there was a high frequency of primary mutations, which offered resistance to nrti and nnrti. Monitoring patients with treatment failure is an important tool for aiding physicians in rescue therapy.

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11.

Comparison of the epidemiology, profile of mutations, and clinical response to antiretrovirals among subtypes B and F of the human immunodeficiency virus type 1
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Lacerda, Heloisa Ramos

; Medeiros, Luzidalva Barbosa de

; Cavalcanti, Ana Maria Salustiano

; Ximenes, Ricardo Arraes de Alencar

; Albuquerque, Maria de Fátima Pessoa Militão de

Memórias do Instituto Oswaldo Cruz

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Set 2007, Volume 102 Nº 6 Páginas 693 - 699

Resumo: En | Texto: En | PDF: En

The authors compared demographic aspects and profile of mutations in 80 patients with subtypes B and F of human immunodeficiency type 1 (HIV-1). Genotyping of the pol region of the reverse transcriptase was performed using the ViroSeqTM Genotyping System. A total of 61 (76.2%) patients had subtype B and 19 (23.8%) subtype F of the HIV-1. Subtype F tended to be more frequent in heterosexuals and women with a low educational level, but without statistical significance. The frequency of mutations related to nucleoside reverse transcriptase inhibitors and protease inhibitors (PI) was the same in the two subtypes, but mutations related to PI at the codons 63, 77, and 71 were more frequent in subtype B, while mutations at the codons 36 and 20 predominated in subtype F. Sixty-two of the 80 patients infected with subtypes B and F were submitted to antiretroviral therapy for an average of 18-22 months. Undetectable viral loads at the end of follow-up were similar in the two groups, representing 63.8% of subtype B and 73.3% of subtype F (p = 0.715). CD4 lymphocyte counts before and after treatment were similar in the two groups. This study, despite pointing to possible epidemiological and genetic differences among subtypes B and F of HIV-1, suggests that the use of highly active antiretroviral therapy is equally effective against these subtypes.

1570 downloads Citado 2 vezes em SciELO

12.

Description and distribution of the larvae of two species of Fistulariidae (Teleostei, Syngnathiformes) in the southeastern Brazil
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Barros, Fernanda Bernardo Anacreto Gomes de

; Castro, Márcia Salustiano de

; Bonecker, Ana Cristina Teixeira

Biota Neotropica

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2007, Volume 7 Nº 1

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

A família Fistulariidae é composta por um único gênero, Fistularia, com quatro espécies; duas delas ocorrem na costa brasileira: Fistularia petimba e F. tabacaria. Este estudo descreve as larvas dessas duas espécies de Fistularia, registrando suas distribuições ao longo da costa sudeste brasileira, que é delimitada ao norte pelo Rio Real (12° S) e ao sul pelo Cabo de São Tomé (22° S). As amostras foram coletadas através de uma rede bongô com aberturas de malha de 330 e 500 µm durante três operações oceanográficas realizadas na primavera/98 (Central III), inverno/99 (Bahia 1) e outono/00 (Central IV). Os arrastos foram oblíquos até a profundidade máxima de 200 m. As larvas de F. petimba foram as mais abundantes, distribuindo-se por toda a área de estudo, incluindo os montes submersos do sistema Vitória-Trindade. Por outro lado, as larvas de F. tabacaria foram coletadas apenas entre as latitudes 14° S e 21° S.

Fistulariidae contains the single genus, Fistularia, with four species. Two of these species are recorded from Brazil: Fistularia petimba and F. tabacaria. This study describes larvae of these two species of Fistularia, recording their distribution along the southeastern Brazilian coast, which is limited in the north by Real River (12° S) and in the south by São Tomé Cape (22° S). Samples were collected using a bongo net with mesh apertures of 330 and 500 µm during three oceanographic cruises conducted on spring/98 (Central III), winter/99 (Bahia 1) and autumn/00 (Central IV). The net was towed obliquely and the maximum depth was 200 m. Larvae of F. petimba were the most abundant and most widely distributed within the study area, including the seamounts of the Vitória-Trindade Ridge. Larvae of F. tabacaria were recorded only between 14° S and 21° S.

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13.

Primary resistance of human immunodeficiency virus type 1 in a reference center in Recife, Pernambuco, Brazil
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Medeiros, Luzidalva Barbosa de

; Lacerda, Heloísa Ramos

; Cavalcanti, Ana Maria Salustiano

; Albuquerque, Maria de Fátima Pessoa Militão de

Memórias do Instituto Oswaldo Cruz

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Dez 2006, Volume 101 Nº 8 Páginas 845 - 849

Resumo: En | Texto: En | PDF: En

To assess the prevalence of primary resistance of human immunodeficiency virus type 1 (HIV-1) to antiretrovirals, 84 patients chronically infected with HIV without prior antiretroviral treatment from Northeast Brazil were studied. Genotyping was performed using the ViroSeqTM Genotyping System. Thimidine analog mutations occurred in 3 (3.6%) patients. Accessory mutations related to NRTI occurred in 6 (7.1%) and related to PI in 67 (79.8%). Subtypes B (72.6%), F (22.6%), B/F 3 (3.6%), and C (1.2%) were detected. A low prevalence of major mutations related to NRTI in patients chronically infected by HIV was observed.

1807 downloads Citado 4 vezes em SciELO

14.

Fatores prognósticos para o desfecho do tratamento da tuberculose pulmonar em Recife, Pernambuco, Brasil
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Albuquerque, Maria de Fatima Militão de

; Leitão, Clézio Cordeiro de Sá

; Campelo, Antônio Roberto Leite

; Souza, Wayner Vieira de

; Salustiano, Ana

Revista Panamericana de Salud Pública

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Jun 2001, Volume 9 Nº 6 Páginas 368 - 374

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Objetivos. O objetivo deste estudo caso-controle foi identificar fatores prognósticos para desfecho do tratamento da tuberculose pulmonar em 297 pacientes (Hospital das Clínicas, Universidade Federal de Pernambuco, Brasil) entre 1994 e 1999. Materiais e métodos. Foram considerados casos indivíduos com alta por óbito, abandono ou falência do tratamento. Os controles foram indivíduos com alta por cura. Foram realizadas análises uni e multivariada com as variáveis independentes sexo; idade; escolaridade; hábito de fumar; hábito de ingerir álcool; tratamento anterior para tuberculose; resposta ao teste tuberculínico; sorologia para HIV; grau de resistência aos antimicrobianos; resultado da pesquisa direta de bacilos álcool-ácido-resistentes; esquema terapêutico utilizado. Além disso, repetiram-se as análises uni e multivariada considerando como casos apenas os óbitos e os indivíduos com falência do tratamento. Resultados. A ingestão excessiva de álcool (OR = 2,58; P = 0,014), a co-infecção pelo HIV (OR = 3,40; P = 0,028), o a tratamento anterior para tuberculose (OR = 4,89; P < 0,001) e resistência a duas ou mais drogas antituberculose (OR = 3,49; P = 0,017) foram fatores de risco para o insucesso do tratamento. Na segunda análise multivariada, excluindo os casos de abandono, não houve associação entre a o ingestão excessiva de álcool e desfecho do tratamento, mantendo-se as demais associações, o que sugere uma estreita relação entre o abandono do tratamento e o etilismo. Conclusões. Os fatores prognósticos para insucesso do tratamento da tuberculose pulmonar entre os indivíduos estudados estão interrelacionados, sendo de natureza biológica, clínica e social. Devem ser identificados no início do tratamento para que sejam implementados procedimentos diferenciados de acompanhamento, tais como tratamento diretamente supervisionado, de forma a fortalecer o controle da tuberculose em nível local.

Objective. The objective of this case-control study was to identify prognostic factors for the outcome of pulmonary tuberculosis among 297 patients who were treated between 1994 and 1999 at the Federal University of Pernambuco Clinics Hospital, in Recife, Pernambuco, Brazil. Methods. The cases were defined as individuals whose treatment ended in death, dropout, or failure. The controls were persons whose treatment ended in cure. The following independent variables were submitted to uni- and multivariate analyses: sex, age, schooling, being a smoker, consuming alcohol, previous treatment for tuberculosis, response to the tuberculin test, HIV serology, resistance to antimicrobial agents, results of direct investigation of alcohol- and acid-resistant bacilli, and treatment approach used. After that, the uni- and multivariate analyses were repeated, including as cases only deaths and individuals with treatment failure. Results. Four risk factors for tuberculosis treatment failure were found: excessive alcohol intake (odds ratio (OR) = 2.58; P = 0.014), co-infection with HIV (OR = 3.40; P = 0.028), previous tuberculosis treatment (OR = 4.89; P < 0.001), and resistance to two or more antituberculosis drugs (OR = 3.49; P = 0.017). In the second multivariate analysis, which excluded dropout cases, no association was found between treatment outcome and excessive alcohol consumption, but the other associations remained. This result suggests a close relationship between alcoholism and treatment dropout. Conclusions. In the group that was studied the prognostic factors for failure of pulmonary tuberculosis treatment were interrelated and were of a biological, clinical, and social character. These factors should be identified at the beginning of treatment in order to allow implementation of specific follow-up procedures such as the strategy of directly observed treatment. This would strengthen tuberculosis control at the local level.

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