ESTRATÉGIAS DIAGNÓSTICAS, TERAPÊUTICAS E DESFECHOS DA TUBERCULOSE EM ADULTOS NUMA UNIDADE DE REFERÊNCIA EM GOIÁS

Abstract

Tuberculosis (TB), especially in HIV co-infection, remains a public health challenge. This study characterized the clinical, epidemiological and laboratory profile of TB in adults treated at a referral unit in Goiás, evaluating the performance of traditional and molecular diagnostic methods. This was a cross-sectional, retrospective, and analytical cohort study conducted at the Dr. Anuar Auad State Hospital for Tropical Diseases (HDT) in Goiás, Brazil, including 303 patients diagnosed with TB in 2023. Clinical, laboratory, and radiological data were analyzed, CD4+ T-cell counts, antiretroviral therapy (ART) use, and clinical outcomes. The mean age of the patients was 42.9 years, with a predominance of males (72.6%) and a high prevalence of HIV coinfection (72.5%). Among the diagnostic methods, sputum culture was the most frequently performed test (88.8%), followed by smear microscopy (80.2%), TRM-TB (69.9%), and TB-LAM (52.1%). TRM-TB demonstrated superior performance, with a sensitivity of 95.5% and substantial agreement with culture (Kappa = 0.671). In contrast, BAAR showed limited sensitivity (47.6%), and TB-LAM demonstrated lower performance (sensitivity of 69.2% and Kappa = 0.178), being more suitable for patients with advanced immunosuppression. Radiologically, the most prevalent findings were air-space nodules (27.7%), tree-in-bud pattern (19.8%), and pulmonary cavitations (18.8%), consistent with active pulmonary TB. Regarding clinical outcomes, 57.7% of patients achieved cure or under clinical follow-up, 21.7% progressed to death, and 14.8% abandoned treatment. Overall, the results underscore the importance of an integrated diagnostic approach, prioritizing TRM-TB for its high accuracy and rapid turnaround,while acknowledging the complementary contributions of BAAR, TB-LAM, and culture. The study also emphasizes the need for continuous laboratory surveillance, early management of HIV/TB coinfection, and strengthening of therapeutic strategies to improve clinical outcomes.