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/μl [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. © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Mortality from HIV and TB coinfections is higher in Eastern Europe than in Western Europe and Argentina / D. N., Podlekareva; A., Mocroft; F. A., Post; V., Riekstina; J. M., Miro; H., Furrer; M., Bruyand; A. M., Panteleev; A. G., Rakhmanova; E., Girardi; M. H., Losso; J. J., Toibaro; J., Cayla; R. F., Miller; N., Obel; A., Skrahina; N., Chentsova; Lichtner, Miriam; J. D., Lundgren; Vullo, Vincenzo; O., Kirk; Hivtb Study Writing, Group. - In: AIDS. - ISSN 0269-9370. - 23:18(2009), pp. 2485-2495. [10.1097/qad.0b013e3283326879]

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

LICHTNER, Miriam;VULLO, Vincenzo;
2009

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/μl [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. © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins.
2009
combination antiretroviral therapy; eastern europe; hiv/tb coinfection; mortality; multidrug-resistant tuberculosis; outcome; tb treatment
01 Pubblicazione su rivista::01a Articolo in rivista
Mortality from HIV and TB coinfections is higher in Eastern Europe than in Western Europe and Argentina / D. N., Podlekareva; A., Mocroft; F. A., Post; V., Riekstina; J. M., Miro; H., Furrer; M., Bruyand; A. M., Panteleev; A. G., Rakhmanova; E., Girardi; M. H., Losso; J. J., Toibaro; J., Cayla; R. F., Miller; N., Obel; A., Skrahina; N., Chentsova; Lichtner, Miriam; J. D., Lundgren; Vullo, Vincenzo; O., Kirk; Hivtb Study Writing, Group. - In: AIDS. - ISSN 0269-9370. - 23:18(2009), pp. 2485-2495. [10.1097/qad.0b013e3283326879]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/229202
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