Mortality from HIV and TB coinfections is higher in Eastern Europe than in Western Europe and Argentina

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningfagfællebedømt

  • Podlekareva, Daria
  • Amanda Mocroft
  • Frank A Post
  • Vija Riekstina
  • Jose M Miro
  • Hansjakob Furrer
  • Mathias Bruyand
  • Alexander M Panteleev
  • Aza G Rakhmanova
  • Enrico Girardi
  • Marcello H Losso
  • Javier J Toibaro
  • Joan Caylá
  • Rob F Miller
  • Obel, Niels
  • Alena Skrahina
  • Nelly Chentsova
  • Lundgren, Jens
  • Kirk, Ole
  • HIV/TB Study Writing Group
BACKGROUND AND OBJECTIVES: Tuberculosis (TB) is a leading cause of death in HIV-infected patients worldwide. We aimed to study clinical characteristics and outcome of 1075 consecutive patients diagnosed with HIV/TB from 2004 to 2006 in Europe and Argentina. METHODS: One-year mortality was assessed in patients stratified according to region of residence, and factors associated with death were evaluated in multivariable Cox models. RESULTS: At TB diagnosis, patients in Eastern Europe had less advanced immunodeficiency, whereas a greater proportion had a history of intravenous drug use, coinfection with hepatitis C, disseminated TB, and infection with drug-resistant TB (P < 0.0001). In Eastern Europe, fewer patients initiated TB treatment containing at least rifamycin, isoniazid, and pyrazinamide or combination antiretroviral therapy (P < 0.0001). Mortality at 1 year was 27% in Eastern Europe, compared with 7, 9 and 11% in Central/Northern Europe, Southern Europe, and Argentina, respectively (P < 0.0001). In a multivariable model, the adjusted relative hazard of death was significantly lower in each of the other regions compared with Eastern Europe: 0.34 (95% confidence interval 0.17-0.65), 0.28 (0.14-0.57), 0.34 (0.15-0.77) in Argentina, Southern Europe and Central/Northern Europe, respectively. Factors significantly associated with increased mortality were CD4 cell count less than 200 cells/microl [2.31 (1.56-3.45)], prior AIDS [1.74 (1.22-2.47)], disseminated TB [2.00 (1.38-2.85)], initiation of TB treatment not including rifamycin, isoniazid and pyrazinamide [1.68 (1.20-2.36)], and rifamycin resistance [2.10 (1.29-3.41)]. Adjusting for these known confounders did not explain the increased mortality seen in Eastern Europe. CONCLUSION: The poor outcome of patients with HIV/TB in Eastern Europe deserves further study and urgent public health attention
Udgivelsesdato: 2009/11/27
Udgave nummer18
Sider (fra-til)2485-95
Antal sider10
StatusUdgivet - 2009

ID: 19663757