TY - JOUR
T1 - One-year mortality of HIV-positive patients treated for rifampicin- and isoniazid-susceptible tuberculosis in Eastern Europe, Western Europe, and Latin America
AU - Podlekareva, DN
AU - Schultze, A
AU - Panteleev, A
AU - Skrahina, AM
AU - Miro, JM
AU - Rakhmanova, A
AU - Furrer, H
AU - Miller, RF
AU - Efsen, AMW
AU - Losso, MH
AU - Toibaro, J
AU - Vassilenko, A.
AU - Girardi, E
AU - Lundgren, JD
AU - Mocroft, A
AU - Post, FA
AU - Kirk, O
AU - TB:HIV Study writing Group
PY - 2017/1/28
Y1 - 2017/1/28
N2 - Objectives: The high mortality among HIV/tuberculosis (TB) coinfected patients in Eastern Europe is partly explained by the high prevalence of drug-resistant TB. It remains unclear whether outcomes of HIV/TB patients with rifampicin/isoniazid-susceptible TB in Eastern Europe differ from those in Western Europe or Latin America. Methods: One-year mortality of HIV-positive patients with rifampicin/isoniazidsusceptible TB in Eastern Europe, Western Europe, and Latin America was analysed and compared in a prospective observational cohort study. Factors associated with death were analysed using Cox regression models Results: Three hundred and forty-one patients were included (Eastern Europe 127, Western Europe 165, Latin America 49). Proportions of patients with disseminated TB (50, 58, 59%) and initiating rifampicin+isoniazid+pyrazinamide-based treatment (93, 94, 94%) were similar in Eastern Europe, Western Europe, and Latin America respectively, whereas receipt of antiretroviral therapy at baseline and after 12 months was lower in Eastern Europe (17, 39, 39%, and 69, 94, 89%). The 1-year probability of death was 16% (95% confidence interval 11-24%) in Eastern Europe, vs. 4% (2-9%) in Western Europe and 9% (3-21%) in Latin America; P<0.0001. After adjustment for IDU, CD4+ cell count and receipt of antiretroviral therapy, those residing in Eastern Europe were at nearly 3-fold increased risk of death compared with those in Western Europe/Latin America (aHR 2.79 (1.15-6.76); P=0.023). Conclusions: Despite comparable use of recommended anti-TB treatment, mortality of patients with rifampicin/isoniazid-susceptible TB remained higher in Eastern Europe when compared with Western Europe/Latin America. The high mortality in Eastern Europe was only partially explained by IDU, use of ART and CD4+ cell count. These results call for improvement of care for TB/HIV patients in Eastern Europe.
AB - Objectives: The high mortality among HIV/tuberculosis (TB) coinfected patients in Eastern Europe is partly explained by the high prevalence of drug-resistant TB. It remains unclear whether outcomes of HIV/TB patients with rifampicin/isoniazid-susceptible TB in Eastern Europe differ from those in Western Europe or Latin America. Methods: One-year mortality of HIV-positive patients with rifampicin/isoniazidsusceptible TB in Eastern Europe, Western Europe, and Latin America was analysed and compared in a prospective observational cohort study. Factors associated with death were analysed using Cox regression models Results: Three hundred and forty-one patients were included (Eastern Europe 127, Western Europe 165, Latin America 49). Proportions of patients with disseminated TB (50, 58, 59%) and initiating rifampicin+isoniazid+pyrazinamide-based treatment (93, 94, 94%) were similar in Eastern Europe, Western Europe, and Latin America respectively, whereas receipt of antiretroviral therapy at baseline and after 12 months was lower in Eastern Europe (17, 39, 39%, and 69, 94, 89%). The 1-year probability of death was 16% (95% confidence interval 11-24%) in Eastern Europe, vs. 4% (2-9%) in Western Europe and 9% (3-21%) in Latin America; P<0.0001. After adjustment for IDU, CD4+ cell count and receipt of antiretroviral therapy, those residing in Eastern Europe were at nearly 3-fold increased risk of death compared with those in Western Europe/Latin America (aHR 2.79 (1.15-6.76); P=0.023). Conclusions: Despite comparable use of recommended anti-TB treatment, mortality of patients with rifampicin/isoniazid-susceptible TB remained higher in Eastern Europe when compared with Western Europe/Latin America. The high mortality in Eastern Europe was only partially explained by IDU, use of ART and CD4+ cell count. These results call for improvement of care for TB/HIV patients in Eastern Europe.
KW - Adult
KW - Antitubercular Agents/therapeutic use
KW - Europe/epidemiology
KW - Europe, Eastern/epidemiology
KW - Female
KW - HIV Infections/complications
KW - Humans
KW - Isoniazid/therapeutic use
KW - Latin America/epidemiology
KW - Male
KW - Prospective Studies
KW - Rifampin/therapeutic use
KW - Survival Analysis
KW - Tuberculosis/drug therapy
U2 - 10.1097/QAD.0000000000001333
DO - 10.1097/QAD.0000000000001333
M3 - Journal article
C2 - 28081036
SN - 0269-9370
VL - 31
SP - 375
EP - 384
JO - AIDS
JF - AIDS
IS - 3
ER -
