Mem Inst Oswaldo Cruz, Rio de Janeiro, Vol. 121 (Suppl. 1) 2026
Research Articles
Impact of the COVID-19 pandemic on mortality among patients with TB–HIV coinfection in the Brazilian Amazon: a case–control study
1Postgraduation Program in Tropical Medicine. Instituto Oswaldo Cruz/Fiocruz, Rio de Janeiro, RJ, Brasil
2Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Diretoria de Assistência Médica, Gerência de Ambulatório, Manaus, AM, Brasil
3Universidade Estadual do Amazonas, Escola Superior de Ciências da Saúde, Curso de Medicina, Disciplina de Doenças Infecciosas e Parasitárias, Manaus, AM, Brasil
4Universidade Nilton Lins, Curso de Medicina, Disciplina de Doenças Infecciosas e Parasitárias, Manaus, AM, Brasil
5Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório de Epidemiologia e Sistemática Molecular, Rio de Janeiro, RJ, Brasil
6Centro Universitário Serra dos Órgãos, Faculdade de Medicina, Internato em Saúde Coletiva, Teresópolis, RJ, Brasil
7Fundação de Vigilância em Saúde do Amazonas Dra. Rosemary Costa Pinto, Centro de Referência para Imunobiológicos Especiais, Manaus, AM, Brasil
8Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Serviço de Terapia Intensiva, Fortaleza, CE, Brasil
9Universidade Estadual do Amazonas, Coordenação de Engenharia Civil, Manaus, AM, Brasil
10Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Diretoria de Ensino e Pesquisa, Gerência de Malária, Manaus, AM, Brasil
11Fundação Oswaldo Cruz-Fiocruz, Instituto Leônidas e Maria Deane, Laboratório Instituto de Pesquisa Clínica Carlos Borborema, Manaus, AM, Brasil
12Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório de Doenças Parasitárias, Rio de Janeiro, RJ, Brasil
BACKGROUND The COVID-19 pandemic disrupted healthcare services worldwide, potentially worsening outcomes for individuals with chronic infectious diseases, including tuberculosis (TB) and HIV.
OBJECTIVE To identify factors associated with mortality among patients with TB–HIV co-infection, and to assess the impact of the COVID-19 pandemic on these outcomes.
METHODS Methods: We analyzed 3,352 TB-HIV cases treated at a referral center in Amazonas, Brazil (2014-2022). Two case-control analyses compared TB-related and non-TB-related deaths with cured TB patients. Multivariate logistic regression was used to identify independent risk factors
RESULTS In TB-related death group, predictors included diagnosis during the COVID-19 pandemic, rural residence, disseminated TB, prior TB treatment, CD4+ <200, and HAART initiation at or after TB diagnosis. Non-TB deaths were associated with age >60, homelessness, disseminated TB, prior treatment, low CD4+, high viral load, and delayed or absent HAART. Both groups reflected advanced disease, immunosuppression, and poor treatment access.
CONCLUSIONS The pandemic increased TB-related mortality but not non-TB deaths. Mortality was also driven by disease severity, delayed care, and social vulnerability, with rural residence highlighting healthcare barriers. Tackling the TB–HIV–COVID-19 syndemic demands integrated, context-sensitive strategies targeting biological, social, and structural determinants to reduce mortality and improve outcomes in high-burden, resource-limited settings
+ Corresponding author: santos.lucilaide@gmail.com | 
https://orcid.org/0009-0008-2261-1810
Received 31 October 2025
