Health care index score and risk of death following tuberculosis diagnosis in HIV-positive patients

Podlekareva, D. N.; Grint, D.; Post, F. A.; Mocroft, A.; Panteleev, A. M.; Miller, R. F.; Miro, J. M.; Bruyand, M.; Furrer, H.; Riekstina, V.; Girardi, E.; Losso, M. H.; Caylá, J. A.; Malashenkov, E. A.; Obel, N.; Skrahina, A. M.; Lundgren, J. D.; Kirk, O. (2013). Health care index score and risk of death following tuberculosis diagnosis in HIV-positive patients. International journal of tuberculosis and lung disease, 17(2), pp. 198-206. International Union Against Tuberculosis and Lung Disease IUATLD 10.5588/ijtld.12.0224

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OBJECTIVES: To assess health care utilisation for patients co-infected with TB and HIV (TB-HIV), and to develop a weighted health care index (HCI) score based on commonly used interventions and compare it with patient outcome. METHODS: A total of 1061 HIV patients diagnosed with TB in four regions, Central/Northern, Southern and Eastern Europe and Argentina, between January 2004 and December 2006 were enrolled in the TB-HIV study. A weighted HCI score (range 0–5), based on independent prognostic factors identified in multivariable Cox models and the final score, included performance of TB drug susceptibility testing (DST), an initial TB regimen containing a rifamycin, isoniazid and pyrazinamide, and start of combination antiretroviral treatment (cART). RESULTS: The mean HCI score was highest in Central/Northern Europe (3.2, 95%CI 3.1–3.3) and lowest in Eastern Europe (1.6, 95%CI 1.5–1.7). The cumulative probability of death 1 year after TB diagnosis decreased from 39% (95%CI 31–48) among patients with an HCI score of 0, to 9% (95%CI 6–13) among those with a score of ≥4. In an adjusted Cox model, a 1-unit increase in the HCI score was associated with 27% reduced mortality (relative hazard 0.73, 95%CI 0.64–0.84). CONCLUSIONS: Our results suggest that DST, standard anti-tuberculosis treatment and early cART may improve outcome for TB-HIV patients. The proposed HCI score provides a tool for future research and monitoring of the management of TB-HIV patients. The highest HCI score may serve as a benchmark to assess TB-HIV management, encouraging continuous health care improvement.

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

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1027-3719

Publisher:

International Union Against Tuberculosis and Lung Disease IUATLD

Language:

English

Submitter:

Annelies Luginbühl

Date Deposited:

21 Mar 2014 09:35

Last Modified:

19 Oct 2015 11:17

Publisher DOI:

10.5588/ijtld.12.0224

Uncontrolled Keywords:

TB-HIV co-infection, TB-HIV health care utilisation, health care index score, outcome of TB-HIV patients

BORIS DOI:

10.7892/boris.44331

URI:

https://boris.unibe.ch/id/eprint/44331

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