With the current trends in integrated management of childhood diseases in developing countries, it is important to resolve the controversies of coinfections between helminths and malaria, and properly evaluate the epidemiology of diarrhegenic parasites with molecular study, which sometimes cause overlapping infections. Again, the major challenge facing the global success of mass deworming initiative aimed at controlling helminths is lack of sustainability due to limited donor funds. We therefore decided to evaluate the effectiveness of a school based deworming program using only the school teachers without spending money on training and logistics. Demographic information, height and weight were measured and stool samples were collected from pupils in a semi-rural area of Nigeria during the initial visit by the study team. Malaria cases were recorded over a 3 month malaria transmission period prior to stool sampling. Four hundred and seventy six (33%) of the study population was infected with one Soil transmitted helminth (STH) or the other, especially with Askaris lumbricoides (26.0%) and Hookworm (8.4%). We found a negative association between malaria and STH in this community. Helminth infection rate of 18.3% was observed in children with malaria compared to 34.4% in controls. We also found a high carriage rate of Giardia (37.2%), low Cryptosporidium (1%) and no E. histolytica infection contrary to previous studies that were based on traditional diagnostic techniques. There was 7.9% reduction in the number children with low weight-for-age in the helminth infected children at 6 months after mass deworming, the number of uninfected children with low weight-for-age also reduced by 3.2%. There was also a reduction in the number of children with more than 25% absenteeism among both helminth infected (13.9%) as well as uninfected (7.2%). The association between malaria and STH in our study calls for the need for integrated approach to health problem in Africa instead of the common vertical campaigns. Results from our molecular study also shows the need to strengthen collaborations between researchers from developed and developing countries to be able to map out the true epidemiology of these parasites and hopefully produce novel, inexpensive diagnostics that circumvent the need for advance technological infrastructure

Thèse numérisée par la Direction des bibliothèques de l'Université de Montréal.

Background: Tuberculosis (TB) and human-immunodeficiency virus (HIV) infections are intertwined through complex biological and social pathways that affect over one million people worldwide. Mitigation of the co-epidemic is undermined by a failure to integrate TB and HIV healthcare services as a result of critical clinical, operational and social challenges. The social challenges of TB/HIV coinfection and integrated care are least understood. Objectives: This research examines the social contexts of TB/HIV illness and related healthcare from the perspective of patients coinfected with TB and HIV. Methods: The study was set within a constructivist-interpretivist theoretical framework. Non-participant field observations and semi-structured in-depth interviews were held with 40 coinfected adults (24 women, 16 men) and 8 healthcare workers at 3 ambulatory clinics in KwaZulu-Natal, South Africa, providing varying models of TB and HIV care. Subjective meanings of illness and healthcare were analyzed in relation to patients’ social contexts. Findings and Interpretations: Coinfection exposes patients to a double and unequal form of social stigma around TB and HIV. Affected individuals construct dual identities and negotiate selective disclosure of TB over HIV in order to manage this double stigma. Their experiences with stigma are bound by social, structural and gendered inequalities, and mediate their decisions to disclose, access and adhere to medical care. Coinfection also exposes patients to pluralistic, disparate and fragmented forms of healthcare delivery. Experiences with stigma and with distinct cultures of TB and HIV care affect their decisions for integrated healthcare. While integration may allow for some technical and clinical efficiency, it may also heighten some patients’ social burden of illness as a result of HIV disclosure and stigmatization. Conclusion: Integration efforts should consider the social contexts of TB/HIV coinfection, social consequences of patients’ health decisions, and paradigms within which such efforts are set in the design and execution of successful interventions.

Background: Tuberculosis (TB) and human-immunodeficiency virus (HIV) infections are intertwined through complex biological and social pathways that affect over one million people worldwide. Mitigation of the co-epidemic is undermined by a failure to integrate TB and HIV healthcare services as a result of critical clinical, operational and social challenges. The social challenges of TB/HIV coinfection and integrated care are least understood. Objectives: This research examines the social contexts of TB/HIV illness and related healthcare from the perspective of patients coinfected with TB and HIV. Methods: The study was set within a constructivist-interpretivist theoretical framework. Non-participant field observations and semi-structured in-depth interviews were held with 40 coinfected adults (24 women, 16 men) and 8 healthcare workers at 3 ambulatory clinics in KwaZulu-Natal, South Africa, providing varying models of TB and HIV care. Subjective meanings of illness and healthcare were analyzed in relation to patients’ social contexts. Findings and Interpretations: Coinfection exposes patients to a double and unequal form of social stigma around TB and HIV. Affected individuals construct dual identities and negotiate selective disclosure of TB over HIV in order to manage this double stigma. Their experiences with stigma are bound by social, structural and gendered inequalities, and mediate their decisions to disclose, access and adhere to medical care. Coinfection also exposes patients to pluralistic, disparate and fragmented forms of healthcare delivery. Experiences with stigma and with distinct cultures of TB and HIV care affect their decisions for integrated healthcare. While integration may allow for some technical and clinical efficiency, it may also heighten some patients’ social burden of illness as a result of HIV disclosure and stigmatization. Conclusion: Integration efforts should consider the social contexts of TB/HIV coinfection, social consequences of patients’ health decisions, and paradigms within which such efforts are set in the design and execution of successful interventions.

The clinical impact of human cytomegalovirus (CMV) and progression to CMV disease in immunocompromised patients has been reduced by therapeutic strategies using ganciclovir, valganciclovir, foscarnet and cidofovir. However, extensive antiviral therapy increases the risk of antiviral resistance due to mutations in the UL97 protein kinase and UL54 DNA polymerase. Co-infection with HHV-6 or HHV-7 is also associated with increased CMV reactivation and disease. Genotypic CMV antiviral resistance was identified in 38% of Australian immunocompromised patients. While UL97 mutations only were identified in 23% of patients, additional UL54 mutations, with the potential to confer multidrug resistance, were detected in 15% of patients. Antiviral resistant CMV strains were found to emerge rapidly in highly immunocompromised patients, and some strains were able to persist in the absence of selective pressure. Three new mutations were identified (UL97 - N597D, UL54 - F412S, D485N). N597D was characterised by recombinant phenotyping and conferred minimal ganciclovir resistance. Neither baculovirus nor coupled transcription/translation yielded full-length UL54 protein (pUL54; ~140 kDa) for activity assays. However, truncated pUL54 (~66 kDa) was purified after prokaryotic expression. HHV-6 and HHV-7 co-infection was a common clinical occurrence; with 36% of liver transplant recipients infected with HHV-6 (11% persistent) and 80% with HHV-7 (52% persistent). ValGCV therapy did not significantly alter the incidence of HHV-6, HHV-7 or co-infection. The most prevalent co-infection pattern was CMV, HHV-6 and HHV-7 (46%) and both CMV and HHV-7 (38%). CMV reactivation was predominantly independent of HHV-6/HHV-7, although 27% of patients had initial HHV-7 reactivation. Despite frequent co-infection, HHV-6 and HHV-7 were not associated with clinical disease, with possible exception of HHV-7 and acute cellular rejection. CMV antiviral resistance remains a significant issue in transplantation, emphasising the importance of antiviral resistance testing in an era of widespread prophylaxis. New mutations in UL97 and UL54 continue to be identified. Further characterisation of UL54 mutations using polymerase activity assays would increase our knowledge of enzymological basis of antiviral resistance. Co-infection with HHV-6 and HHV-7 is common in transplant recipients, but does not play a significant role in disease. Similar co-infection rates between valGCV-treated and untreated patients indicate that valGCV is not highly effective against HHV-6 and HHV-7.

Thesis (MSc (Mathematics))--University of Stellenbosch, 2009. / ENGLISH ABSTRACT: In this thesis, a mathematical model describing the interaction between HIV and TB in the presence of TB superinfection is presented. The model takes into account two strains of Mycobacterium tuberculosis (MTB), where one strain is drug-sensitive and the other is resistant to at least one of the first-line anti-tuberculosis drugs. The impact of TB superinfection on the incidence and prevalence of TB in HIV-negative and HIVTB coinfected individuals is evaluated. Various control measures such as condom use, antiretroviral therapy, isoniazid preventive therapy and increased TB detection are studied using this model. Numerical results show that TB superinfection increases the prevalence and incidence of TB and its impact is more in HIV-negative than HIV-TB coinfected individuals. The results also show that TB superinfection promotes strain coexistence and increases the associated HIV mortality. Increased condom use was found to have a high positive impact towards the control of the two epidemics. Antiretroviral therapy decreases the TB notification rate and its impact on HIV prevalence increases with the coverage and efficacy. Isoniazid preventive therapy has a clear effect on the TB prevalence. Finally, increased TB detection was found to have a less impact on the TB incidence in HIV-TB coinfected individuals / AFRIKAANSE OPSOMMING: In hierdie verhandeling word ´n wiskundige model vir die interaksie tussen MIV en TB, in ´n situasie met TB superinfeksie voorgelˆe. Die model neem twee variante van TB in ag. Een van die variante is sensitief vir MTB behandeling, terwyl die ander weerstandig is vir ten minste een van die eerste-linie TB behandenings. Die impak van TB superinfeksie op die insidensie and prevalensie van TB in MIV negatiewe en MIV-TB ko-ge˜ınfekteerde individu word ondersoek. Veskeie beheer maatreels soos kondoom gebruik, anti-retrovirale behandeling (vir MIV) en isonazid voorkomende behandeling en verhoodge TB deteksie (vir TB) word ondersoek. Numeriese resultate wys TB superinfeksie verhoog die prevalense en insidensie van TB en dat dit ´n groter bydrae maak by MIV negatief as by MIV-TB ko-geinfekteerde individu. Die resultate wys veder TB superinfeksie promofeer variant kohabitasie en verhoog MIV verwante mortalitieit. Verhoogde kondoom gebruik is gevind om ´n positiewe bydrae te maak tot die beheer van beide epidemies. Anti-retrovirale terapie verlaag die TB aanmeldings koers en die impak van ART verhoog saam met ´n verhoging in die dekking en effektiwiteit daarvan. Voorkomende behandeling het ´n beduidende impak op TB prevalensie. Ons vind dat TB deteksie ´n beperkte impak maak op TB insidensie by MIV-TB ko-geinfekteerde individu

The subject of this thesis is the study of a system of multiple simultaneously spreading diseases, or strains of diseases, in a structured host population. The disease spread is modelled using the well-studied SEIR compartmental model; host population structure is imposed through the use of random graphs, in which each host individual is explicitly connected to a predetermined set of other individuals. Two different graph structures are used: Zipf power-law distributed graphs, in which individuals vary greatly in their number of contacts; and Poisson distributed graphs, in which there is very little variation in the number of contacts. Three separate explorations are undertaken. In the first, the extent to which two SEIR processes will overlap due to chance is examined in the case where they do not affect each other's ability to spread. The overlap is found to increase with increased heterogeneity in the number of contacts, all things equal. Introducing differences in infection probability or a delay between introducing the two strains produces more complex dynamics. I then extend the model to allow strains to modify each other's transmissibility. This is found to lead to modest changes in the size of the outbreak of affected strains, and larger effects on the size of the overlap. The extent of the effect is found to depend strongly on the order in which the strains are introduced to the population. Zipf graphs experience somewhat larger reductions in outbreak size and less reduction of overlap size, but overall the two graphs experience similar effects. This is due to the reduced effect of modification in key high-degree vertices in the Zipf graph being offset by higher local clustering. Finally, I introduce recombination and competition by replacement into the model from the first project. The number of recombinant strains that arise is found to be either very low or very high, with chance governing which occurs. Recombinant strains in Zipf distributed graphs have a significant chance of failing to spread, but not in Poisson distributed graphs. Replacement competition in the presence of a growing number of strains is found to both increase the chance of a strain failing to spread, and to reduce the overall size of outbreaks. This effect is equal in both graph types.

Submitted by Ana Maria Fiscina Sampaio (fiscina@bahia.fiocruz.br) on 2016-02-04T15:41:20Z No. of bitstreams: 1 Rayssa Maria de Araujo Carvalho Estudo da coinfecção...2015.pdf: 2144928 bytes, checksum: 48b23a40107abab111363e306597b10d (MD5) / Approved for entry into archive by Ana Maria Fiscina Sampaio (fiscina@bahia.fiocruz.br) on 2016-02-04T15:41:45Z (GMT) No. of bitstreams: 1 Rayssa Maria de Araujo Carvalho Estudo da coinfecção...2015.pdf: 2144928 bytes, checksum: 48b23a40107abab111363e306597b10d (MD5) / Made available in DSpace on 2016-02-04T15:41:45Z (GMT). No. of bitstreams: 1 Rayssa Maria de Araujo Carvalho Estudo da coinfecção...2015.pdf: 2144928 bytes, checksum: 48b23a40107abab111363e306597b10d (MD5) Previous issue date: 2015 / Fundação Oswaldo Cruz, Centro de Pesquisas Gonçalo Moniz. Salvador, BA, Brasil / Universidade Federal da Bahia, Faculdade de Medicina. Salvador, BA, Brasil / A Erliquiose Monocítica Canina (EMC) e a Leishmaniose Visceral Canina (LVC) são duas doenças, transmitidas por vetores, com ampla distribuição mundial. Os agentes causadores dessas doenças são Ehrlichia canis e Leishmania infantum, respectivamente. Enquanto a EMC é transmitida por carrapatos, principalmente Rhipicephalus sanguineus, a Leishmania é inoculada no hospedeiro através do inseto-vetor da subfamilia Phlebotominae. A maioria dos sinais físicos são comuns às duas enfermidades, o que dificulta o diagnóstico clínico e o tratamento, especialmente em áreas endêmicas. Poucos são os estudos relacionados à coinfecção da erliquiose e leishmaniose caninas no Brasil. No Piauí, particularmente em Teresina, ainda não se tem dados concretos sobre a prevalência dessas afecções.Os sinais físicos variam com a severidade da infecção, a resposta imune do hospedeiro e a presença de coinfecção. Assim, buscamos avaliar cães, independente dos sinais físicos, atendidos no hospital universitário e clínicas particulares da cidade de Teresina, Piauí quanto a frequência de erliquiose e leishmaniose caninas no período de março de 2012 a setembro de 2014, independente de sexo, raça, idade e suspeita clínica, excetuando os cães que vinham apenas para vacinação. Foi realizado exame clínico e colhidas amostras sanguíneas para exame hematimétrico, bioquímico, parasitológico e molecular. Dos 664 cães avaliados para E. canis, 22,9% tiveram o DNA amplificado somente para esta bactéria. No caso de Leishmania infantum, houve amplificação de DNA em 29,1% dos 664 cães, sendo que, destes, 80 (12,1%) estavam coinfectados com E.canis. Anemia e trombocitopenia foram as principais alterações hematológicas observadas em cães infectados tanto com E. canis, como com L. infantum e coinfectados. As principais alterações bioquímicas nos cães com infecção apenas por L. infantum, assim como nos coinfectados, foram hipoglobulinemia e hiperproteinemia. Já nos monoinfectados por E. canis a hipoalbuminemia e a uremia foram as principais alterações. Perda de peso, úlceras, apatia, conjuntivite, palidez nas mucosas, alópecia e linfoadenomegalia são mais frequentes em cães monoinfectados com L. infantum do que nos infectados apenas com E. canis. Além disso, os cães coinfectados apresentam uma doença mais severa do que os monoinfectados. Concluímos que a presença da coinfecção por esses agentes infecciosos é endêmica na cidade de Teresina-Piauí e que existe um sinergismo entra as duas doenças.Portanto, destacamos aqui a relevância dos estudos voltados a epidemiologia e melhoria dos testes diagnósticos para uma prevenção e/ou controle mais eficazes dessas doenças. Palavras / The Canine Monocytic Ehrlichiosis (CME) and Canine Visceral Leishmaniasis (CVL) are the two vector-borne diseases with worldwide distribution. The causative agents of these diseases are Ehrlichia canis and Leishmania infantum, respectively. While CME is transmitted by ticks, especially Rhipicephalus sanguineus, Leishmania is inoculated into the host through the insect vector of the subfamily Phlebotominae. Most clinical signs are common to both conditions, which hinders the clinical diagnosis and treatment, especially in endemic areas. There are few studies related to the coinfection of canine ehrlichiosis and leishmaniasis in Brazil. In Piaui, particularly in Teresina, there is not yet concrete data on the prevalence of these diseases. The clinical signs vary according to the severity of the infection, to the host immune response and to the presence of coinfection. Thus, we sought to evaluate dogs, regardless of clinical signs, seen at university hospital and private clinics in the city of Teresina, Piauí, for the frequency of canine ehrlichiosis and leishmaniasis from March 2012 to September 2014, regardless of sex, race, age and clinical suspicion, except dogs that came just to vaccination purposes. Clinical examination was performed and blood samples for erythrocyte examination, biochemical, and molecular parasitology were collected. From 664 dogs evaluated for E. canis, 22, 9% showed amplified DNA, to this bacterium only . Regarding to Leishmania infantum, there was DNA amplification in 29, 1% out of the 664 dogs, and, from these, 80 (12, 1%) were coinfected with E. canis. Anemia and thrombocytopenia were major hematologic changes observed in dogs infected with Leishmania, E.canis and coinfected dogs. The main biochemical findings in dogs infected by L. infantum and coinfected were hyperalbuminemia, hypoglobulinemia and hyperproteinemia. In those infected only by E. canis, hypoalbuminemia and uremia were the main changes. Weight loss, skin lesions, lethargy, conjunctivitis, pale mucous membranes, alopecia and enlarged lymphnodes are more common in dogs with L. infantum than in dogs infected only with E.canis. In addition, the coinfected dogs have a more severe disease than the ones with only one infection. We conclude that the presence of coinfection by these infectious agents are endemic in the city of Teresina, Piauí, and that there is a synergism between the two diseases. Therefore, we highlight here the relevance of studies regarding epidemiology and improvement of diagnostic tests for prevention and / or control of the diseases in a more effective way.

Submitted by Fabio Sobreira Campos da Costa (fabio.sobreira@ufpe.br) on 2016-06-22T13:38:45Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) DISSERTAÇÃO FINAL - VERSÃO DIGITAL.pdf: 1043362 bytes, checksum: 3fd98b19c10f0a1b432a656183f47936 (MD5) / Made available in DSpace on 2016-06-22T13:38:45Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) DISSERTAÇÃO FINAL - VERSÃO DIGITAL.pdf: 1043362 bytes, checksum: 3fd98b19c10f0a1b432a656183f47936 (MD5) Previous issue date: 2015-08-31 / Estima-se que 33 milhões de pessoas vivam com HIV no mundo, enquanto 15 a 20 milhões sejam infectadas pelo HTLV-1/2, como ambos compartilham as mesmas vias de transmissão a coinfecção tem sido relatada; os pacientes coinfectados podem apresentar maior contagem de LTCD4, retardando o diagnóstico de aids, assim como progredir mais rapidamente para a imunossupressão, além de evoluírem com sintomas de TSP/HAM mais precoce e frequentemente.O objetivo deste estudo foi estimar a prevalência e os fatores de risco associados à coinfecção em pessoas vivendo com HIV/aids atendidos no Hospital Clementino Fraga, João Pessoa-PB, no período de fevereiro a julho de 2015. Trata-se de um estudo transversal analítico; os pacientes foram abordados no momento da coleta de sangue para exames de contagem de LTCD4 e carga viral do HIV de rotina, submetidos à entrevista para coleta de dados sócio-epidemiológicos após assinatura do temo de consentimento livre e esclarecido e então encaminhados para a coleta de sangue, que era então enviado ao Setor de Virologia do LIKA da UFPE para detecção de anti-HTLV por ELISA; as contagens de LTCD4 e carga viral, assim como data de diagnóstico foram obtidas dos prontuários. Foram analisados 401 indivíduos vivendo com HIV/aids, 271 eram do sexo masculino, 60,8% solteiros e 196 de raça branca; a média de idade foi 41,3 anos A prevalência da coinfecção HIV/HTLV foi de 1,5%, e no presente trabalho não houve associação de maior risco de coinfecção com cirurgia ou hemotransfusão prévias, piercings ou tatuagens, compartilhamento de seringas ou história de drogas injetáveis, bem como com o comportamento sexual dos participantes. As médias das primeiras e últimas contagens de LTCD4 e carga viral do HIV foram semelhantes entre os dois grupos. Os resultados mostram que a Paraíba difere de outras regiões do país, com baixa prevalência de coinfecção, provavelmente por características epidemiológicas e culturais de sua população, o que mostra a importância de mais estudos de prevalência como este, visto que o Brasil apresenta marcantes diferenças inter-regionais no perfil de sua população. / t is estimated that 33 million people live with HIV worldwide, while 15-20 million are infected with HTLV-1/2, as both share the same transmission routes coinfection has been reported; the coinfected patients may have higher LTCD4 counts, delaying diagnosis of AIDS, progress more quickly to immunosuppression and present symptoms of TSP/HAM earlier and oftentimes. The aim of this study was to estimate the prevalence and risk factors associated to coinfection in people living with HIV/aids treated at the Hospital Clementino Fraga, João Pessoa, Paraíba, from february to July 2015. This is an analytical cross-sectional study; patients were approached at the time of blood collection for LTCD4 count and HIV viral load tests of routine, subjected to an interview for collect socio-demographic data after signing a informed consent and then forwarded to collect blood, which was sent to the Department of Virology of LIKA-UFPE to detect anti-HTLV by ELISA; LTCD4 counts and viral load, as well the date of diagnosis were obtained from medical records. Were analyzed 401 individuals living with HIV/aids, 271 were male, 60,8% single and 196 whites; the mean age was 41,3 years. The prevalence of coinfection HIV/HTLV was 1,5%, and in this study there was no association of increased risk of coinfection with previous surgery or blood transfusion, piercings or tattoos, needle sharing or story injecting drugs, as well as the sexual behavior of participants. The mean of the first and last LTCD4 counts and HIV viral load were similar between the two groups. The results show that the Paraíba differs from other regions of the country with low prevalence of coinfection, probably by epidemiological and cultural characteristics of its population, which shows the importance of more prevalence studies like this, since Brazil presents significant inter-regional differences in the population.

Submitted by Cássia Santos (cassia.bcufg@gmail.com) on 2015-03-05T12:33:52Z No. of bitstreams: 2 Dissertação - Christiane Moreira Souza - 2014.pdf: 1441222 bytes, checksum: cad3b73e713dcfed6bbf1d0600f3311e (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2015-03-06T10:39:32Z (GMT) No. of bitstreams: 2 Dissertação - Christiane Moreira Souza - 2014.pdf: 1441222 bytes, checksum: cad3b73e713dcfed6bbf1d0600f3311e (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2015-03-06T10:39:32Z (GMT). No. of bitstreams: 2 Dissertação - Christiane Moreira Souza - 2014.pdf: 1441222 bytes, checksum: cad3b73e713dcfed6bbf1d0600f3311e (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2014-04-28 / Fundação de Amparo à Pesquisa do Estado de Goiás - FAPEG / The HIV/TB coinfection represents a challenge for public health, since this association has impacted both the epidemiology, natural history and clinical course of both diseases. The aim of this study was to analyze the survival of individuals coinfected with HIV and with Mtb in Goiás. This is a retrospective epidemiological cohort study (2003-2011) individuals with HIV infection who developed tuberculosis during the study period. Linkage was performed between the medical records of patients followed up at a referral hospital with database SINAN- TB and SIM Goiás. The cumulative probability of survival was calculated by Kaplan-Meier. Among coinfected patients, the mean age was 35.2 years; the majority were male (74.1%); with less than eight years of education (45.6%); unmarried (67.4%); black or brown (78.5%) and in the interior of Goiás (70.7%). The incidence of coinfection HIV/TB was 7.1%. Yet, coinfected showed 61.5% of the LT- counting CD4 <350 cells/mm3; underwent 83.0 % AFB and 42.2 % PPD. The extrapulmonary forms and mixed accounted for 76.7% of cases. Scheme I was mostly used to treat TB (86.3 %) and 67.4 % of coinfected initiated the use of ART. Death occurred in 36.7% of coinfected. Univariate analysis identified that have counts of the first LT - CD4 < 350 cells/mm3 was associated with the development of TB (OR: 2.93); death was double among patients with co-infection (OR: 2.07) and that males are more affected by TB (OR: 1.79). The analysis of cumulative survival identified that 4.0% of coinfected with TB while the diagnosis of HIV; the development of TB was higher for males (p < 0.001); individuals with count values LT - CD4 + ≤ 00 ce s/ mm3 had a higher probability of having TB (p < 0.001) and did not initiate ART within 24 months after the diagnosis of tuberculosis has contributed significantly to the increase in the rate of deaths (p < 0.001). It is necessary to develop joint policies aimed at reducing the clinical and epidemiological impact of a disease on the other, making priority: early detection of HIV and TB, adherence to ART, TB research in individuals with HIV, treatment / A coinfecção HIV/TB representa um desafio para a saúde pública, uma vez que essa associação tem impactado simultaneamente a epidemiologia, a história natural e a evolução clínica de ambas as doenças. O objetivo deste estudo foi analisar a sobrevida de indivíduos coinfectados pelo HIV e Mtb em Goiás. Trata-se de um estudo de coorte retrospectiva (2003-2011) de natureza epidemiológica com indivíduos infectados pelo HIV e que desenvolveram tuberculose no período do estudo. Foi realizado linkage entre os registros dos prontuários dos pacientes em seguimento no hospital de referência com a base de dados do SINAN-TB e SIM de Goiás. A probabilidade acumulada de sobrevida foi calculada pelo método de Kaplan-Meier. Dentre os coinfectados, a média de idade foi 35,2 anos; a maioria era do sexo masculino (74,1%); com escolaridade inferior a oito anos de estudo (45,6%); não casados (67,4%); negros ou pardos (78,5%) e residentes no interior de Goiás (70,7%). A incidência da coinfecção HIV/TB foi de 7,1%. Ainda, 61,5% dos coinfectados apresentaram contagem de LT-CD4+ <350 cel/mm3; 83,0% realizaram BAAR e 42,2% o PPD. As formas extrapulmonar e a mista representaram 76,7% dos casos. O Esquema I foi o mais utilizado para tratamento de TB (86,3%) e 67,4% dos coinfectados iniciaram o uso da TARV. O óbito ocorreu para 36,7% dos coinfectados. A análise univariada identificou que possuir contagem do primeiro LT-CD4+ < 350 cel/mm3 esteve associado ao desenvolvimento de TB (OR: 2,93); o óbito foi o dobro entre os portadores da coinfecção (OR: 2,07) e que o sexo masculino foi o mais acometido pela TB (OR: 1,79). A análise da sobrevida acumulada identificou que 4,0% dos coinfectados desenvolveram TB simultaneamente ao diagnóstico de HIV; o desenvolvimento de TB foi maior para o sexo masculino (p< 0,001); indivíduos com valores da contagem de LT-CD4+ ≤ 00 cel/mm3 tiveram maior probabilidade de apresentar TB (p< 0,001) e não ter iniciado a TARV em até 24 meses após o diagnóstico de tuberculose, o que contribuiu significativamente para o aumento da taxa de óbitos (p< 0,001). Faz-se necessário o desenvolvimento de políticas conjuntas que visem diminuir o impacto epidemiológico e clínico de uma doença sobre a outra, tornando prioridades: a detecção precoce do HIV e TB, adesão a TARV, investigação de TB nos indivíduos portadores de HIV, tratamento da TB latente, ampliação do tratamento diretamente observado e capacitação dos profissionais.