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

Podlekareva, Daria N; Mocroft, Amanda; Post, Frank A; Riekstina, Vija; Miro, Jose M; Furrer, Hansjakob; Bruyand, Mathias; Panteleev, Alexander M; Rakhmanova, Aza G; Girardi, Enrico; Losso, Marcello H; Toibaro, Javier J; Caylá, Joan; Miller, Rob F; Obel, Niels; Skrahina, Alena; Chentsova, Nelly; Lundgren, Jens D; Kirk, Ole (2009). Mortality from HIV and TB coinfections is higher in Eastern Europe than in Western Europe and Argentina. AIDS, 23(18), pp. 2485-95. Hagerstown, Md.: Lippincott Williams & Wilkins 10.1097/QAD.0b013e3283326879

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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.

Item Type:	Journal Article (Original Article)
Division/Institute:	04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Infectiology
UniBE Contributor:	Furrer, Hansjakob
ISSN:	0269-9370
Publisher:	Lippincott Williams & Wilkins
Language:	English
Submitter:	Factscience Import
Date Deposited:	04 Oct 2013 15:14
Last Modified:	05 Dec 2022 14:22
Publisher DOI:	10.1097/QAD.0b013e3283326879
PubMed ID:	19898216
Web of Science ID:	000272135800013
URI:	https://boris.unibe.ch/id/eprint/32449 (FactScience: 197657)