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

Daria Podlekareva; 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; Niels Obel; Alena Skrahina; Nelly Chentsova; Jens Lundgren; Ole Kirk; HIV/TB Study Writing Group

doi:10.1097/QAD.0b013e3283326879

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

Daria Podlekareva, 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, Niels Obel, Alena Skrahina, Nelly Chentsova, Jens Lundgren, Ole Kirk, HIV/TB Study Writing Group

LUKKET: Institut for Immunologi og Mikrobiologi

37 Citationer (Scopus)

Abstract

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

Originalsprog	Engelsk
Tidsskrift	AIDS
Vol/bind	23
Udgave nummer	18
Sider (fra-til)	2485-95
Antal sider	10
ISSN	0269-9370
DOI	https://doi.org/10.1097/QAD.0b013e3283326879 https://doi.org/10.1097/QAD.0b013e3283326879
Status	Udgivet - 2009

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Podlekareva, D., Mocroft, A., Post, F. A., Riekstina, V., Miro, J. M., Furrer, H., Bruyand, M., Panteleev, A. M., Rakhmanova, A. G., Girardi, E., Losso, M. H., Toibaro, J. J., Caylá, J., Miller, R. F., Obel, N., Skrahina, A., Chentsova, N., Lundgren, J., Kirk, O., & HIV/TB Study Writing Group (2009). Mortality from HIV and TB coinfections is higher in Eastern Europe than in Western Europe and Argentina. AIDS, 23(18), 2485-95. https://doi.org/10.1097/QAD.0b013e3283326879, https://doi.org/10.1097/QAD.0b013e3283326879

Podlekareva, D, Mocroft, A, Post, FA, Riekstina, V, Miro, JM, Furrer, H, Bruyand, M, Panteleev, AM, Rakhmanova, AG, Girardi, E, Losso, MH, Toibaro, JJ, Caylá, J, Miller, RF, Obel, N, Skrahina, A, Chentsova, N, Lundgren, J , Kirk, O & HIV/TB Study Writing Group 2009, 'Mortality from HIV and TB coinfections is higher in Eastern Europe than in Western Europe and Argentina', AIDS, bind 23, nr. 18, s. 2485-95. https://doi.org/10.1097/QAD.0b013e3283326879, https://doi.org/10.1097/QAD.0b013e3283326879

@article{5c0519205c1911df928f000ea68e967b,

title = "Mortality from HIV and TB coinfections is higher in Eastern Europe than in Western Europe and Argentina",

abstract = "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.",

author = "Daria Podlekareva and Amanda Mocroft and Post, {Frank A} and Vija Riekstina and Miro, {Jose M} and Hansjakob Furrer and Mathias Bruyand and Panteleev, {Alexander M} and Rakhmanova, {Aza G} and Enrico Girardi and Losso, {Marcello H} and Toibaro, {Javier J} and Joan Cayl{\'a} and Miller, {Rob F} and Niels Obel and Alena Skrahina and Nelly Chentsova and Jens Lundgren and Ole Kirk and {HIV/TB Study Writing Group}",

year = "2009",

doi = "10.1097/QAD.0b013e3283326879",

language = "English",

volume = "23",

pages = "2485--95",

journal = "AIDS, Supplement",

issn = "1350-2840",

publisher = "Lippincott Williams & Wilkins",

number = "18",

}

TY - JOUR

T1 - Mortality from HIV and TB coinfections is higher in Eastern Europe than in Western Europe and Argentina

AU - Podlekareva, Daria

AU - Mocroft, Amanda

AU - Post, Frank A

AU - Riekstina, Vija

AU - Miro, Jose M

AU - Furrer, Hansjakob

AU - Bruyand, Mathias

AU - Panteleev, Alexander M

AU - Rakhmanova, Aza G

AU - Girardi, Enrico

AU - Losso, Marcello H

AU - Toibaro, Javier J

AU - Caylá, Joan

AU - Miller, Rob F

AU - Obel, Niels

AU - Skrahina, Alena

AU - Chentsova, Nelly

AU - Lundgren, Jens

AU - Kirk, Ole

AU - HIV/TB Study Writing Group

PY - 2009

Y1 - 2009

N2 - 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.

AB - 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.

U2 - 10.1097/QAD.0b013e3283326879

DO - 10.1097/QAD.0b013e3283326879

M3 - Journal article

C2 - 19898216

SN - 1350-2840

VL - 23

SP - 2485

EP - 2495

JO - AIDS, Supplement

JF - AIDS, Supplement

IS - 18

ER -

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

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