Delayed diagnosis of tuberculosis in persons living with HIV in Eastern Europe: associated factors and effect on mortality—a multicentre prospective cohort study
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Delayed diagnosis of tuberculosis in persons living with HIV in Eastern Europe : associated factors and effect on mortality—a multicentre prospective cohort study. / Kraef, Christian; Bentzon, Adrian; Panteleev, Alexander; Skrahina, Alena; Bolokadze, Natalie; Tetradov, Simona; Podlasin, Regina; Karpov, Igor; Borodulina, Elena; Denisova, Elena; Azina, Inga; Lundgren, Jens; Johansen, Isik Somuncu; Mocroft, Amanda; Podlekareva, Daria; Kirk, Ole; Vassilenko, A.; Klimuk, D.; Kondratenko, O.; Zalutskaya, A.; Bondarenko, V.; Mitsura, V.; Kozorez, E.; Tumash, O.; Suetnov, O.; Paduto, D.; Iljina, V.; Kummik, T.; Mshvidobadze, K.; Lanchava, N.; Goginashvili, L.; Mikiashvili, L.; Bablishvili, N.; Rozentale, B.; Zeltina, I.; Janushkevich, I.; Caplinskiene, I.; Caplinskas, S.; Kancauskiene, Z.; Wiercinska-Drapalo, A.; Thompson, M.; Kozlowska, J.; Grezesczuk, A.; Bura, M.; Knysz, B.; Inglot, M.; Garlicki, A.; Obel, N.; Gerstoft, J.; Kronborg, G.; for the T. B.:H. I. V. Study Group.
I: BMC Infectious Diseases, Bind 21, Nr. 1, 1038, 2021.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Delayed diagnosis of tuberculosis in persons living with HIV in Eastern Europe
T2 - associated factors and effect on mortality—a multicentre prospective cohort study
AU - Kraef, Christian
AU - Bentzon, Adrian
AU - Panteleev, Alexander
AU - Skrahina, Alena
AU - Bolokadze, Natalie
AU - Tetradov, Simona
AU - Podlasin, Regina
AU - Karpov, Igor
AU - Borodulina, Elena
AU - Denisova, Elena
AU - Azina, Inga
AU - Lundgren, Jens
AU - Johansen, Isik Somuncu
AU - Mocroft, Amanda
AU - Podlekareva, Daria
AU - Kirk, Ole
AU - Vassilenko, A.
AU - Klimuk, D.
AU - Kondratenko, O.
AU - Zalutskaya, A.
AU - Bondarenko, V.
AU - Mitsura, V.
AU - Kozorez, E.
AU - Tumash, O.
AU - Suetnov, O.
AU - Paduto, D.
AU - Iljina, V.
AU - Kummik, T.
AU - Mshvidobadze, K.
AU - Lanchava, N.
AU - Goginashvili, L.
AU - Mikiashvili, L.
AU - Bablishvili, N.
AU - Rozentale, B.
AU - Zeltina, I.
AU - Janushkevich, I.
AU - Caplinskiene, I.
AU - Caplinskas, S.
AU - Kancauskiene, Z.
AU - Wiercinska-Drapalo, A.
AU - Thompson, M.
AU - Kozlowska, J.
AU - Grezesczuk, A.
AU - Bura, M.
AU - Knysz, B.
AU - Inglot, M.
AU - Garlicki, A.
AU - Obel, N.
AU - Gerstoft, J.
AU - Kronborg, G.
AU - for the T. B.:H. I. V. Study Group
N1 - Publisher Copyright: © 2021, The Author(s).
PY - 2021
Y1 - 2021
N2 - Background: Early diagnosis of tuberculosis (TB) is important to reduce transmission, morbidity and mortality in people living with HIV (PLWH). Methods: PLWH with a diagnosis of TB were enrolled from HIV and TB clinics in Eastern Europe and followed until 24 months. Delayed diagnosis was defined as duration of TB symptoms (cough, weight-loss or fever) for ≥ 1 month before TB diagnosis. Risk factors for delayed TB diagnosis were assessed using multivariable logistic regression. The effect of delayed diagnosis on mortality was assessed using Kaplan–Meier estimates and Cox models. Findings: 480/740 patients (64.9%; 95% CI 61.3–68.3%) experienced a delayed diagnosis. Age ≥ 50 years (vs. < 50 years, aOR = 2.51; 1.18–5.32; p = 0.016), injecting drug use (IDU) (vs. non-IDU aOR = 1.66; 1.21–2.29; p = 0.002), being ART naïve (aOR = 1.77; 1.24–2.54; p = 0.002), disseminated TB (vs. pulmonary TB, aOR = 1.56, 1.10–2.19, p = 0.012), and presenting with weight loss (vs. no weight loss, aOR = 1.63; 1.18–2.24; p = 0.003) were associated with delayed diagnosis. PLWH with a delayed diagnosis were at 36% increased risk of death (hazard ratio = 1.36; 1.04–1.77; p = 0.023, adjusted hazard ratio 1.27; 0.95–1.70; p = 0.103). Conclusion: Nearly two thirds of PLWH with TB in Eastern Europe had a delayed TB diagnosis, in particular those of older age, people who inject drugs, ART naïve, with disseminated disease, and presenting with weight loss. Patients with delayed TB diagnosis were subsequently at higher risk of death in unadjusted analysis. There is a need for optimisation of the current TB diagnostic cascade and HIV care in PLWH in Eastern Europe.
AB - Background: Early diagnosis of tuberculosis (TB) is important to reduce transmission, morbidity and mortality in people living with HIV (PLWH). Methods: PLWH with a diagnosis of TB were enrolled from HIV and TB clinics in Eastern Europe and followed until 24 months. Delayed diagnosis was defined as duration of TB symptoms (cough, weight-loss or fever) for ≥ 1 month before TB diagnosis. Risk factors for delayed TB diagnosis were assessed using multivariable logistic regression. The effect of delayed diagnosis on mortality was assessed using Kaplan–Meier estimates and Cox models. Findings: 480/740 patients (64.9%; 95% CI 61.3–68.3%) experienced a delayed diagnosis. Age ≥ 50 years (vs. < 50 years, aOR = 2.51; 1.18–5.32; p = 0.016), injecting drug use (IDU) (vs. non-IDU aOR = 1.66; 1.21–2.29; p = 0.002), being ART naïve (aOR = 1.77; 1.24–2.54; p = 0.002), disseminated TB (vs. pulmonary TB, aOR = 1.56, 1.10–2.19, p = 0.012), and presenting with weight loss (vs. no weight loss, aOR = 1.63; 1.18–2.24; p = 0.003) were associated with delayed diagnosis. PLWH with a delayed diagnosis were at 36% increased risk of death (hazard ratio = 1.36; 1.04–1.77; p = 0.023, adjusted hazard ratio 1.27; 0.95–1.70; p = 0.103). Conclusion: Nearly two thirds of PLWH with TB in Eastern Europe had a delayed TB diagnosis, in particular those of older age, people who inject drugs, ART naïve, with disseminated disease, and presenting with weight loss. Patients with delayed TB diagnosis were subsequently at higher risk of death in unadjusted analysis. There is a need for optimisation of the current TB diagnostic cascade and HIV care in PLWH in Eastern Europe.
U2 - 10.1186/s12879-021-06745-w
DO - 10.1186/s12879-021-06745-w
M3 - Journal article
C2 - 34615474
AN - SCOPUS:85116576750
VL - 21
JO - B M C Infectious Diseases
JF - B M C Infectious Diseases
SN - 1471-2334
IS - 1
M1 - 1038
ER -
ID: 303681748